Provider Demographics
NPI:1457640112
Name:MID-MICHIGAN ENDOSCOPY CENTER, PLLC
Entity Type:Organization
Organization Name:MID-MICHIGAN ENDOSCOPY CENTER, PLLC
Other - Org Name:CHARTER ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BALVANT
Authorized Official - Middle Name:K
Authorized Official - Last Name:GANATRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-230-7200
Mailing Address - Street 1:1144 CHARTER DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3586
Mailing Address - Country:US
Mailing Address - Phone:810-230-7200
Mailing Address - Fax:810-230-9200
Practice Address - Street 1:1144 CHARTER DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3586
Practice Address - Country:US
Practice Address - Phone:810-230-7200
Practice Address - Fax:810-230-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical