Provider Demographics
NPI:1659574283
Name:PROVIDENCE VENTURES, LLC
Entity Type:Organization
Organization Name:PROVIDENCE VENTURES, LLC
Other - Org Name:BONE AND JOINT SURGERY CENTER OF NOVI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GOVERNING BOARD PRESIDENT/CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOROVOY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-388-5842
Mailing Address - Street 1:26750 PROVIDENCE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1211
Mailing Address - Country:US
Mailing Address - Phone:248-662-1500
Mailing Address - Fax:248-662-1501
Practice Address - Street 1:26750 PROVIDENCE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1211
Practice Address - Country:US
Practice Address - Phone:248-662-1500
Practice Address - Fax:248-662-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-10
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical