Provider Demographics
NPI:1740341411
Name:STURGIS SURGICARE
Entity type:Organization
Organization Name:STURGIS SURGICARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:PMAC
Authorized Official - Phone:269-651-5379
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-0249
Mailing Address - Country:US
Mailing Address - Phone:269-651-5379
Mailing Address - Fax:269-659-4704
Practice Address - Street 1:102 S LAKEVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091
Practice Address - Country:US
Practice Address - Phone:269-651-5379
Practice Address - Fax:269-659-4704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric