Provider Demographics
NPI:1962463133
Name:SURGICAL CENTERS OF MICHIGAN, LLC.
Entity Type:Organization
Organization Name:SURGICAL CENTERS OF MICHIGAN, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-726-8423
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 1:4600 INVESTMENT DR
Practice Address - Street 2:STE 270
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6365
Practice Address - Country:US
Practice Address - Phone:586-726-8423
Practice Address - Fax:586-726-8557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI636907261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI40001OtherBLUE CROSS BLUE SHIELD MI
MI636907OtherMI STATE LICENSE
MI0N48330Medicare PIN