# NEWCO AMBULATORY SURGERY CENTER, LLP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LAKESHORE SURGERY CENTER, LLP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629079611
- **Authorized official:** MR. TIMOTHY P CONNELL (ADMINISTRATOR)
- **Authorized official phone:** (810) 989-7751

## Contact information

- **Practice address:** 4190 24TH AVE, FORT GRATIOT, MI 48059-3882
- **Practice address phone:** (810) 989-7649
- **Practice address fax:** (810) 989-7652
- **Mailing address:** 4190 24TH AVE, FORT GRATIOT, MI 48059-3882
- **Mailing address fax:** (810) 989-7652

## Taxonomy

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

## Other

- **Enumeration date:** 08/02/2005
- **Last updated:** 08/22/2020