Provider Demographics
NPI:1376574814
Name:ROCHESTER ENDOSCOPY & SURGERY CENTER, L.L.C.
Entity Type:Organization
Organization Name:ROCHESTER ENDOSCOPY & SURGERY CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CORDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-794-7730
Mailing Address - Street 1:1349 S ROCHESTER RD STE 150
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3152
Mailing Address - Country:US
Mailing Address - Phone:248-844-3800
Mailing Address - Fax:
Practice Address - Street 1:1349 S ROCHESTER RD STE 150
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3152
Practice Address - Country:US
Practice Address - Phone:248-844-3800
Practice Address - Fax:248-844-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI636917261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
23C0001057Medicare ID - Type UnspecifiedAMBULATORY SURGERY CENTER