Organization
NEWCO AMBULATORY SURGERY CENTER, LLP
Active
Other names
LAKESHORE SURGERY CENTER, LLP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY P CONNELL (ADMINISTRATOR)
(810) 989-7751
Entity
Organization
Contact information
Practice address
4190 24TH AVE, FORT GRATIOT, MI 48059-3882
(810) 989-7649
(810) 989-7652
Mailing address
4190 24TH AVE, FORT GRATIOT, MI 48059-3882
(810) 989-7652
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
746818
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139016
PREFERRED CHOICES
—
01
—
143728
GREAT LAKES HEALTH PLAN
MI
01
—
30036708
FIRST HEALTH
—
01
—
32463
HEALTH PLAN OF MICHIGAN
—
01
—
40221
BLUE CROSS BLUE SHIELD
MI
01
—
40221
BLUE CARE NETWORK
—
01
—
4563971
CIGNA
—
Enumeration date
08/02/2005
Last updated
08/22/2020
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