# LAKE GEORGE SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457960536
- **Authorized official:** KATHY MECCIA RNBC, BSN, CNOR (RN ADMINISTRATOR)
- **Authorized official phone:** (517) 462-8283

## Contact information

- **Practice address:** 6245 N OLD 27 STE A10, FREMONT, IN 46737-8707
- **Practice address phone:** (517) 462-8283
- **Mailing address:** 302 N FISKE RD, COLDWATER, MI 49036-9138
- **Mailing address phone:** (517) 462-8283

## Taxonomy

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

## Other

- **Enumeration date:** 07/24/2020
- **Last updated:** 09/25/2020