Provider Demographics
NPI:1467788729
Name:WATERFORD SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:WATERFORD SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SUCCAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-889-4580
Mailing Address - Street 1:5220 HIGHLAND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1975
Mailing Address - Country:US
Mailing Address - Phone:248-889-4580
Mailing Address - Fax:248-889-4582
Practice Address - Street 1:5220 HIGHLAND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1975
Practice Address - Country:US
Practice Address - Phone:248-889-4580
Practice Address - Fax:248-889-4582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical