Healthcare Provider Details

I. General information

NPI: 1962479014
Provider Name (Legal Business Name): LANSING SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 LAKE LANSING RD
LANSING MI
48912-3742
US

IV. Provider business mailing address

1707 LAKE LANSING RD
LANSING MI
48912-3742
US

V. Phone/Fax

Practice location:
  • Phone: 517-267-0033
  • Fax: 517-267-0430
Mailing address:
  • Phone: 517-267-0033
  • Fax: 517-267-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number336816
License Number StateMI

VIII. Authorized Official

Name: DR. JOHN WALLING
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 517-267-0033