Provider Demographics
NPI:1962479014
Name:LANSING SURGERY CENTER
Entity Type:Organization
Organization Name:LANSING SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-267-0033
Mailing Address - Street 1:1707 LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3742
Mailing Address - Country:US
Mailing Address - Phone:517-267-0033
Mailing Address - Fax:517-267-0430
Practice Address - Street 1:1707 LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3742
Practice Address - Country:US
Practice Address - Phone:517-267-0033
Practice Address - Fax:517-267-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI336816261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C37000OtherBCBSM 2ND
MI40354OtherBLUE CROSS BLUE SHIELD
MI0M26720Medicare PIN
MI0C37000OtherBCBSM 2ND