Organization
JACKSON GASTROENTEROLOGY CENTER, LLC
Active
Other names
East Jackson Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RODNEY LUNN (MEMBER)
(615) 425-0818
Entity
Organization
Contact information
Practice address
4400 ANN ARBOR ROAD, JACKSON, MI 49202
(517) 990-0602
Mailing address
4400 ANN ARBOR ROAD, JACKSON, MI 49202
(517) 990-0602
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38-6814
FACILITY NUMBER
MI
Enumeration date
01/11/2008
Last updated
10/20/2008
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