Provider Demographics
NPI:1376728642
Name:LANSING HERNIA CENTER PC
Entity Type:Organization
Organization Name:LANSING HERNIA CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCGILLICUDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-372-9880
Mailing Address - Street 1:901 E MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3207
Mailing Address - Country:US
Mailing Address - Phone:517-372-9880
Mailing Address - Fax:517-372-9882
Practice Address - Street 1:901 E MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3207
Practice Address - Country:US
Practice Address - Phone:517-372-9880
Practice Address - Fax:517-372-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM026995208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000002374OtherPHYSICIANS HEALTH PLAN