Healthcare Provider Details

I. General information

NPI: 1528039567
Provider Name (Legal Business Name): PREMIER PROFESSIONAL SURGERY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2006
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 VILLA LINDE PKWY
FLINT MI
48532-3411
US

IV. Provider business mailing address

5014 VILLA LINDE PKWY
FLINT MI
48532-3411
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-5450
  • Fax: 810-733-8130
Mailing address:
  • Phone: 810-733-5450
  • Fax: 810-733-8130

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: HEATHER LAFFREY
Title or Position: MANAGER
Credential:
Phone: 810-733-5450