Organization
SURGICAL SPECIALISTS OF ST. JOSEPH, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYN A. HASTINGS (ADMINISTRATOR)
(269) 983-3368
Entity
Organization
Contact information
Practice address
2990 NILES RD, SAINT JOSEPH, MI 49085-8607
(269) 983-3368
(269) 983-2758
Mailing address
2990 NILES RD, SAINT JOSEPH, MI 49085-8607
(269) 983-3368
(269) 983-2758
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020A110340
BCBS GROUP
MI
Enumeration date
12/13/2006
Last updated
07/20/2011
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