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Organization
NEWCO AMBULATORY SURGERY CENTER, LLP
Active
Organization
NEWCO AMBULATORY SURGERY CENTER, LLP
Active
Other names
LAKESHORE SURGERY CENTER, LLP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY P CONNELL (ADMINISTRATOR)
(810) 989-7751
Entity
Organization
Contact information
Practice address
4190 24TH AVE, FORT GRATIOT, MI 48059-3882
(810) 989-7649
(810) 989-7652
Mailing address
4190 24TH AVE, FORT GRATIOT, MI 48059-3882
(810) 989-7652
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
746818
MI
Other
Enumeration date
08/02/2005
Last updated
08/22/2020
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