Healthcare Provider Details

I. General information

NPI: 1790306991
Provider Name (Legal Business Name): GRASS LAKE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 CENTENNIAL BLVD
GRASS LAKE MI
49240
US

IV. Provider business mailing address

3800 CENTENNIAL DR
GRASS LAKE MI
49240-8961
US

V. Phone/Fax

Practice location:
  • Phone: 517-701-3100
  • Fax:
Mailing address:
  • Phone: 517-701-3100
  • 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: WENDY STARK-RIEMER
Title or Position: VP
Credential:
Phone: 615-656-0917