Provider Demographics
NPI:1386220895
Name:BLOOMFIELD HILLS SURGERY CENTER
Entity Type:Organization
Organization Name:BLOOMFIELD HILLS SURGERY CENTER
Other - Org Name:BLOOMFIELD HILLS SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:BILJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-220-7505
Mailing Address - Street 1:359 ENTERPRISE CT STE C
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0305
Mailing Address - Country:US
Mailing Address - Phone:248-220-7505
Mailing Address - Fax:248-985-3355
Practice Address - Street 1:359 ENTERPRISE CT
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0305
Practice Address - Country:US
Practice Address - Phone:248-220-7505
Practice Address - Fax:248-985-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI63-6035OtherCON APPLICATION NO. 20-0034