Provider Demographics
NPI:1467544684
Name:TOWNE CENTRE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:TOWNE CENTRE SURGERY CENTER, LLC
Other - Org Name:ST. MARY'S OF MICHIGAN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:989-497-3096
Mailing Address - Street 1:4599 TOWNE CENTRE ROAD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604
Mailing Address - Country:US
Mailing Address - Phone:989-497-3096
Mailing Address - Fax:989-497-3048
Practice Address - Street 1:4599 TOWNE CENTRE ROAD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604
Practice Address - Country:US
Practice Address - Phone:989-497-3096
Practice Address - Fax:989-497-3048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI736821OtherSTATE LICENSE
MIOP4595Medicare PIN