Healthcare Provider Details

I. General information

NPI: 1922911544
Provider Name (Legal Business Name): GRAND RIVER SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 TROWBRIDGE RD STE A
EAST LANSING MI
48823-5257
US

IV. Provider business mailing address

1090 TROWBRIDGE RD STE A
EAST LANSING MI
48823-5257
US

V. Phone/Fax

Practice location:
  • Phone: 517-220-0240
  • Fax: 517-200-4455
Mailing address:
  • Phone: 517-220-0240
  • Fax: 517-200-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: TAMARA JEAN WRIGHT
Title or Position: ADMINISTRATOR
Credential: BSN, RN
Phone: 517-282-0851