Provider Demographics
NPI:1770577637
Name:SURGERY CENTER PLC
Entity type:Organization
Organization Name:SURGERY CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOCHSTETLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-929-2500
Mailing Address - Street 1:5080 N ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9230
Mailing Address - Country:US
Mailing Address - Phone:231-929-2500
Mailing Address - Fax:231-929-0963
Practice Address - Street 1:5080 N ROYAL DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9230
Practice Address - Country:US
Practice Address - Phone:231-929-2500
Practice Address - Fax:231-929-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITH048021207W00000X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI050B810950OtherBCBS MD ANES GROUP
MI40364OtherBCBS - TSC
MI900003210OtherPRIORITY - TSC
MI430B810310OtherBCBS CRNA GROUP
MI490003947OtherMEDICARE RR
MI490B870000OtherBCBS
MI0M58250Medicare PIN
MI900003210OtherPRIORITY - TSC
MI490B870000OtherBCBS
MI0N90640Medicare PIN