Provider Demographics
NPI:1023693389
Name:ASCENSION MEDICAL GROUP-SURGICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:ASCENSION MEDICAL GROUP-SURGICAL ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-938-1133
Mailing Address - Street 1:8235 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2441
Mailing Address - Country:US
Mailing Address - Phone:810-694-9700
Mailing Address - Fax:810-694-9940
Practice Address - Street 1:8235 HOLLY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2441
Practice Address - Country:US
Practice Address - Phone:810-694-9700
Practice Address - Fax:810-694-9940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty