Provider Demographics
NPI:1700980406
Name:MICHIGAN OUTPATIENT SURGERY CENTER INC
Entity Type:Organization
Organization Name:MICHIGAN OUTPATIENT SURGERY CENTER INC
Other - Org Name:MICHIGAN OUTPATIENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAHDI
Authorized Official - Middle Name:M
Authorized Official - Last Name:BASHA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-296-7250
Mailing Address - Street 1:PO BOX 26010
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-6010
Mailing Address - Country:US
Mailing Address - Phone:586-296-7250
Mailing Address - Fax:586-296-7256
Practice Address - Street 1:33080 UTICA RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-2038
Practice Address - Country:US
Practice Address - Phone:586-296-7250
Practice Address - Fax:586-296-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI506810261QA1903X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF0529OtherBLUE CROSS
MICC0338Medicare PIN
MIF0529OtherBLUE CROSS
MI490000273Medicare PIN