Provider Demographics
NPI:1376618595
Name:SURGICAL ASSOCIATES OF MIDMICHIGAN PC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF MIDMICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESICENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHEPICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-631-6710
Mailing Address - Street 1:4007 ORCHARD DR
Mailing Address - Street 2:SUITE 2003
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6113
Mailing Address - Country:US
Mailing Address - Phone:989-631-6710
Mailing Address - Fax:989-631-8583
Practice Address - Street 1:4007 ORCHARD DR
Practice Address - Street 2:SUITE 2003
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6113
Practice Address - Country:US
Practice Address - Phone:989-631-6710
Practice Address - Fax:989-631-8583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059228174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICF9107Medicare ID - Type UnspecifiedRR MDCR GROUP NO
MI0E664453022Medicare ID - Type UnspecifiedMDCR COMMON PROVIDER NO.