Organization
NORTHWEST MICHIGAN SURGERY CENTER LLC
Active
Other names
Copper Ridge Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
TINA L PIOTROWSKI (CEO)
(231) 392-8950
Entity
Organization
Contact information
Practice address
4100 PARK FOREST DRIVE, TRAVERSE CITY, MI 49684-6725
(231) 392-8900
(231) 392-8973
Mailing address
4100 PARK FOREST DRIVE, TRAVERSE CITY, MI 49684-6725
(231) 392-8900
(231) 392-8973
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
286173
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00099448
RAILROAD MEDICARE
GA
01
—
104539
HEALTH PARTNERS
MN
01
—
38217
PRIORITY HEALTH
MI
01
—
40340
BLUE CROSS BLUE SHIELD MI
MI
01
—
487354900
US DEPT OF LABOR
KY
01
—
487354900
ASR CORP
MI
01
—
P118278
BLUE CARE NETWORK MI
MI
Enumeration date
10/27/2005
Last updated
06/04/2019
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