Provider Demographics
NPI:1942393475
Name:NORTH OAKLAND ASC LLC
Entity Type:Organization
Organization Name:NORTH OAKLAND ASC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DERUBEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-857-7583
Mailing Address - Street 1:461 WEST HURON ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-0000
Mailing Address - Country:US
Mailing Address - Phone:248-857-7583
Mailing Address - Fax:248-857-7588
Practice Address - Street 1:1305 NORTH OAKLAND BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1547
Practice Address - Country:US
Practice Address - Phone:248-666-5552
Practice Address - Fax:248-666-5549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKLAND PHYSICIANS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI636823261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI141676OtherCARE CHOICES
MI17412OtherMCARE
MI40347OtherBCBS - FACILITY
MI490F32891OtherBCBS - PROFESSIONAL
MIB0100OtherBCN
MIB0100OtherBCN