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General NPI Number Information
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NPI Number | 1083814701
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Entity Type | Organization
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Legal Business Name | WEST BRANCH SURGICAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 117 S BURGESS ST
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City | WEST BRANCH
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State | MI
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Zip | 48661-1403
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Country | US
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Telephone | 989-345-2234
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Fax | 989-345-7066
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Provider Business Mailing Address
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Address Line | 117 S BURGESS ST
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City | WEST BRANCH
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State | MI
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Zip | 48661-1403
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Country | US
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Telephone | 989-345-2234
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Fax | 989-345-7066
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAY DANIEL COLLINS
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Credential | M.D.
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Telephone | 989-345-2234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4301042486
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License Number State | MI
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