Organization
CENTER FOR DIGESTIVE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANA COOPER (ADMINISTRATOR)
(734) 528-1405
Entity
Organization
Contact information
Practice address
5300 ELLIOTT DR, YPSILANTI, MI 48197
(734) 434-6262
Mailing address
5300 ELLIOTT DR, YPSILANTI, MI 48197
(734) 434-6262
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
81-6818
MI
367H00000X
Anesthesiologist Assistant
4704111201
MI
367H00000X
Anesthesiologist Assistant
4704118315
MI
367H00000X
Anesthesiologist Assistant
4704204265
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23C0001056
MEDICARE SUPPLIER #
MI
01
—
40378
BCBS FACILITY NUMBER
MI
01
—
B0109
BCN NUMBER
MI
01
—
P01162164
MEDICARE RAILROAD
MI
Enumeration date
09/15/2006
Last updated
08/25/2015
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