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General NPI Number Information
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NPI Number | 1134363690
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Entity Type | Organization
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Legal Business Name | OAM SURGERY CENTER AT MIDTOWNE, LLC
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 555 MIDTOWNE ST NE SUITE 200
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-5729
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Country | US
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Telephone | 616-552-5000
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Fax | 616-552-5006
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Provider Business Mailing Address
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Address Line | 555 MIDTOWNE ST NE STE 200
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-5731
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Country | US
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Telephone | 616-552-5000
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Fax | 616-552-5006
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | VIET HUU DO
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Credential |
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Telephone | 616-459-7101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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