Organization
THE SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER GROCHOWALSKI (ADMINISTRATION)
(231) 929-3888
Entity
Organization
Contact information
Practice address
5080 N ROYAL DR, TRAVERSE CITY, MI 49684-9230
(231) 929-3888
(231) 929-4365
Mailing address
5080 N ROYAL DR, TRAVERSE CITY, MI 49684-9230
(231) 929-3888
(231) 929-4365
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG1308
CRNA/MD RAILROAD MEDICARE
MI
Enumeration date
04/23/2007
Last updated
10/26/2007
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