Provider Demographics
NPI:1407539315
Name:MOTOWN CHILDREN'S SURGERY CENTER LLC
Entity Type:Organization
Organization Name:MOTOWN CHILDREN'S SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-494-3000
Mailing Address - Street 1:33545 CHERRY HILL RD FL 2
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-4842
Mailing Address - Country:US
Mailing Address - Phone:301-349-3000
Mailing Address - Fax:301-307-5555
Practice Address - Street 1:33545 CHERRY HILL RD FL 2
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4842
Practice Address - Country:US
Practice Address - Phone:301-349-3000
Practice Address - Fax:301-307-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty