Provider Demographics
NPI:1528219474
Name:CLARKSTON ASC PARTNERS LLC
Entity Type:Organization
Organization Name:CLARKSTON ASC PARTNERS LLC
Other - Org Name:CLARKSTON SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3859
Mailing Address - Street 1:5701 BOW POINTE DR
Mailing Address - Street 2:SUITE 145
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3163
Mailing Address - Country:US
Mailing Address - Phone:248-922-4800
Mailing Address - Fax:248-241-6625
Practice Address - Street 1:5701 BOW POINTE DR
Practice Address - Street 2:SUITE 145
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3163
Practice Address - Country:US
Practice Address - Phone:248-922-4800
Practice Address - Fax:248-241-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1599096261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2336Medicare PIN
MI23C0001109Medicare Oscar/Certification