# PRIME HEALTHCARE SERVICES-PORT HURON, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PRIME HEALTHCARE SERVICES-PORT HURON, LLC
- **Other names:** Lakeshore Surgery Center, LLP
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1134586852
- **Legal business name:** PRIME HEALTHCARE SERVICES-PORT HURON, LLC
- **Authorized official:** CHRISTOPHER DOAN (CHIEF COMPLIANCE COUNSEL)
- **Authorized official phone:** (909) 235-4307

## Contact information

- **Practice address:** 4190 24TH AVE, FORT GRATIOT, MI 48059-3882
- **Practice address phone:** (810) 989-7700
- **Mailing address:** 4190 24TH AVE, FORT GRATIOT, MI 48059-3882
- **Mailing address phone:** (810) 989-7700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 746818 | MI | Yes |

## Other

- **Enumeration date:** 01/26/2016
- **Last updated:** 01/26/2016