Healthcare Provider Details

I. General information

NPI: 1942851639
Provider Name (Legal Business Name): NORTHERN MICHIGAN SURGICAL SUITES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 MOLL DR
BOYNE CITY MI
49712-9182
US

IV. Provider business mailing address

825 MOLL DR
BOYNE CITY MI
49712-9182
US

V. Phone/Fax

Practice location:
  • Phone: 231-497-1031
  • Fax: 231-459-4313
Mailing address:
  • Phone: 231-497-1031
  • Fax: 231-459-4313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BAILEY
Title or Position: MARKET PRESIDENT
Credential:
Phone: 203-609-1168