Organization
NEWCO AMBULATORY SURGERY CENTER, LLP
Active
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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