Provider Demographics
NPI:1265487474
Name:HORSESHOE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:HORSESHOE SURGERY CENTER, LLC
Other - Org Name:LAKEWOOD SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SKELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-326-3937
Mailing Address - Street 1:1542 GOLF COURSE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-9603
Mailing Address - Country:US
Mailing Address - Phone:218-326-0667
Mailing Address - Fax:218-326-3435
Practice Address - Street 1:1542 GOLF COURSE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-9603
Practice Address - Country:US
Practice Address - Phone:218-326-0667
Practice Address - Fax:218-326-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical