Healthcare Provider Details

I. General information

NPI: 1134363690
Provider Name (Legal Business Name): OAM SURGERY CENTER AT MIDTOWNE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MIDTOWNE ST NE SUITE 200
GRAND RAPIDS MI
49503-5729
US

IV. Provider business mailing address

555 MIDTOWNE ST NE STE 200
GRAND RAPIDS MI
49503-5731
US

V. Phone/Fax

Practice location:
  • Phone: 616-552-5000
  • Fax: 616-552-5006
Mailing address:
  • Phone: 616-552-5000
  • Fax: 616-552-5006

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: VIET HUU DO
Title or Position: CHAIRMAN OF THE BOARD
Credential:
Phone: 616-459-7101