Healthcare Provider Details

I. General information

NPI: 1639868771
Provider Name (Legal Business Name): LAKE LANSING SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 02/06/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7397 E SAGINAW ST
EAST LANSING MI
48823-9666
US

IV. Provider business mailing address

500 W MADISON ST STE 3110
CHICAGO IL
60661-2588
US

V. Phone/Fax

Practice location:
  • Phone: 630-886-1304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARTHA HAMMOND
Title or Position: REGIONAL ASC DIRECTOR
Credential:
Phone: 517-879-6663