Provider Demographics
NPI:1790109445
Name:MICHIGAN AMBULATORY SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:MICHIGAN AMBULATORY SURGICAL CENTER, LLC
Other - Org Name:SPECIALTY SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:BRECKENRIDGE
Authorized Official - Last Name:CORDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-206-2990
Mailing Address - Street 1:22000 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2500
Mailing Address - Country:US
Mailing Address - Phone:248-206-2990
Mailing Address - Fax:248-206-2991
Practice Address - Street 1:22000 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2500
Practice Address - Country:US
Practice Address - Phone:248-206-2990
Practice Address - Fax:248-206-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical