Provider Demographics
NPI:1356773584
Name:SURGERY CENTER OF MUNSTER, LLC
Entity type:Organization
Organization Name:SURGERY CENTER OF MUNSTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-961-9621
Mailing Address - Street 1:9200 CALUMET AVE
Mailing Address - Street 2:SUITE S200
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2885
Mailing Address - Country:US
Mailing Address - Phone:513-561-8900
Mailing Address - Fax:513-561-8901
Practice Address - Street 1:9200 CALUMET AVE
Practice Address - Street 2:SUITE S200
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2885
Practice Address - Country:US
Practice Address - Phone:513-561-8900
Practice Address - Fax:513-561-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical