Provider Demographics
NPI:1700967106
Name:EBSC, LLC
Entity Type:Organization
Organization Name:EBSC, LLC
Other - Org Name:SURGICAL CARE CENTER OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:616-580-6520
Mailing Address - Street 1:750 EAST BELTLINE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6049
Mailing Address - Country:US
Mailing Address - Phone:616-940-3600
Mailing Address - Fax:616-954-0216
Practice Address - Street 1:750 EAST BELTLINE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6049
Practice Address - Country:US
Practice Address - Phone:616-940-3600
Practice Address - Fax:616-954-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI490001454OtherMEDICARE RR
MI490001454OtherMEDICARE RR