Provider Demographics
NPI:1801907944
Name:LANSING SURGICAL ASSOCIATES, P.L.L.C.
Entity type:Organization
Organization Name:LANSING SURGICAL ASSOCIATES, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-487-8255
Mailing Address - Street 1:2720 S WASHINGTON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-2873
Mailing Address - Country:US
Mailing Address - Phone:517-487-8255
Mailing Address - Fax:517-487-2059
Practice Address - Street 1:2720 S WASHINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2873
Practice Address - Country:US
Practice Address - Phone:517-487-8255
Practice Address - Fax:517-487-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMJ010550208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4908848Medicaid
MI1020399OtherMCLAREN
MI5331174OtherBCBSM
MI0253311744OtherBCBSM
MI200000002185OtherPHYSICIANS HEALTH PLAN
MIP00397821OtherMEDICARE RAILROAD
MIF04787Medicare UPIN
MI1020399OtherMCLAREN