Provider Demographics
NPI:1942637301
Name:MICHIANA SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:MICHIANA SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AJIT
Authorized Official - Middle Name:V
Authorized Official - Last Name:PAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-855-2223
Mailing Address - Street 1:3212 HICKORY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-8862
Mailing Address - Country:US
Mailing Address - Phone:574-855-2223
Mailing Address - Fax:574-251-0068
Practice Address - Street 1:3212 HICKORY RD
Practice Address - Street 2:SUITE A
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8862
Practice Address - Country:US
Practice Address - Phone:574-855-2223
Practice Address - Fax:574-251-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical