Provider Demographics
NPI:1528039567
Name:PREMIER PROFESSIONAL SURGERY CENTER PC
Entity Type:Organization
Organization Name:PREMIER PROFESSIONAL SURGERY CENTER PC
Other - Org Name:PARKEYE SURGI CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-733-5450
Mailing Address - Street 1:5014 VILLA LINDE PKWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3411
Mailing Address - Country:US
Mailing Address - Phone:810-733-5450
Mailing Address - Fax:810-733-8130
Practice Address - Street 1:5014 VILLA LINDE PKWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3411
Practice Address - Country:US
Practice Address - Phone:810-733-5450
Practice Address - Fax:810-733-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-29
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P44900Medicare PIN
0B57000Medicare PIN