Provider Demographics
NPI:1235372277
Name:LAGRANGE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:LAGRANGE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSARI-NAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-202-7174
Mailing Address - Street 1:500 ARCADE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2478
Mailing Address - Country:US
Mailing Address - Phone:574-296-6452
Mailing Address - Fax:574-296-6484
Practice Address - Street 1:2500 VENTURA WAY
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761
Practice Address - Country:US
Practice Address - Phone:574-296-6452
Practice Address - Fax:574-296-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty