Healthcare Provider Details

I. General information

NPI: 1801164355
Provider Name (Legal Business Name): MIDWEST SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SCHAEFER RD
DEARBORN MI
48126-3698
US

IV. Provider business mailing address

26901 BEAUMONT BLVD COMPLIANCE
SOUTHFIELD MI
48033
US

V. Phone/Fax

Practice location:
  • Phone: 313-581-2600
  • Fax: 313-581-0228
Mailing address:
  • Phone: 947-522-1964
  • Fax:

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: LEE ANN ODOM
Title or Position: PRESIDENT SHARED SERVICES
Credential:
Phone: 947-522-3326