Organization
NEWCO AMBULATORY SURGERY CENTER, LLP
Active
Other names
Lakeshore Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL LYNN BURGETT (ADMINISTRATOR)
(810) 989-7751
Entity
Organization
Contact information
Practice address
4190 24TH AVE, FORT GRATIOT, MI 48059-3882
(810) 989-7651
Mailing address
4190 24TH AVE, FORT GRATIOT, MI 48059-3882
(810) 989-7651
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7238585
AETNA
MI
Enumeration date
05/30/2006
Last updated
08/22/2020
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