Organization
SURGICAL SERVICES OF MICHIGAN, LLC
Active
Other names
Blake Woods Medical Park
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BROOKE A DAY (CHIEF EXECUTIVE OFFICER)
(517) 787-2906
Entity
Organization
Contact information
Practice address
2775 BLAKE ROAD, JACKSON, MI 49201-8838
(517) 787-2906
(517) 787-3039
Mailing address
2775 BLAKE ROAD, JACKSON, MI 49201-8838
(517) 787-2906
(517) 787-3039
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40366
BCBSM FACILITY PIN
MI
01
—
490003502
RAILROAD MEDICARE
MI
01
—
490C870000
BCBSM PROFESSIONAL PIN
MI
Enumeration date
03/07/2006
Last updated
10/27/2011
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