Provider Demographics
NPI:1457960536
Name:LAKE GEORGE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:LAKE GEORGE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MECCIA
Authorized Official - Suffix:
Authorized Official - Credentials:RNBC, BSN, CNOR
Authorized Official - Phone:517-462-8283
Mailing Address - Street 1:302 N FISKE RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-9138
Mailing Address - Country:US
Mailing Address - Phone:517-462-8283
Mailing Address - Fax:
Practice Address - Street 1:6245 N OLD 27 STE A10
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:IN
Practice Address - Zip Code:46737-8707
Practice Address - Country:US
Practice Address - Phone:517-462-8283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical