Healthcare Provider Details

I. General information

NPI: 1295930402
Provider Name (Legal Business Name): ST. PAUL SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5085 MONROE ST STE B
TOLEDO OH
43623-3455
US

IV. Provider business mailing address

1180 N MONROE ST
MONROE MI
48162-3190
US

V. Phone/Fax

Practice location:
  • Phone: 734-243-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GINNY MARTIN
Title or Position: VICE PRESIDENT - OPERATIONS
Credential: CMA, CPC, CHCO, CHBC
Phone: 734-243-5300