Provider Demographics
NPI:1407954365
Name:ASC-TCG, LLC
Entity Type:Organization
Organization Name:ASC-TCG, LLC
Other - Org Name:TRI-COUNTY CENTER FOR ENDOSCOPY & SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CORDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-329-1884
Mailing Address - Street 1:37399 GARFIELD ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036
Mailing Address - Country:US
Mailing Address - Phone:586-498-9440
Mailing Address - Fax:586-498-9460
Practice Address - Street 1:37399 GARFIELD ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036
Practice Address - Country:US
Practice Address - Phone:586-228-5300
Practice Address - Fax:586-228-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI506850261QA1903X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N81740Medicare Oscar/Certification