Healthcare Provider Details

I. General information

NPI: 1639476377
Provider Name (Legal Business Name): LIVONIA OUTPATIENT SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33400 6 MILE RD SUITE B
LIVONIA MI
48152-3143
US

IV. Provider business mailing address

33400 6 MILE RD SUITE B
LIVONIA MI
48152-3143
US

V. Phone/Fax

Practice location:
  • Phone: 810-623-1482
  • Fax:
Mailing address:
  • Phone: 347-452-7111
  • Fax: 734-452-7121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: CANDICE B DAVIS
Title or Position: CHIEF REVENUE CYCLE OFFICER
Credential:
Phone: 916-990-7590