Provider Demographics
NPI:1629075106
Name:MICHIGAN ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:MICHIGAN ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOHLFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-589-9024
Mailing Address - Street 1:2500 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1098
Mailing Address - Country:US
Mailing Address - Phone:215-589-9024
Mailing Address - Fax:833-705-6301
Practice Address - Street 1:30055 NORTHWESTERN HWY
Practice Address - Street 2:SUITE L-60
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3230
Practice Address - Country:US
Practice Address - Phone:248-865-6555
Practice Address - Fax:248-865-6554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
23-C0001045OtherMEDICARE ASC NUMBER
23D1006055OtherCLIA CERTIFICATE
23389OtherAAAHC ACCREDITATION
MI40373OtherBCBSMI
MI010473OtherCERTIFICATE OF NEED
MI636910OtherSTATE LICENESE
23-C0001045OtherMEDICARE ASC NUMBER