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General NPI Number Information
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NPI Number | 1215097340
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Entity Type | Organization
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Legal Business Name | ASC - UTICA
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 11051 HALL RD STE 230
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City | UTICA
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State | MI
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Zip | 48317-5742
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Country | US
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Telephone | 586-254-2280
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Fax |
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Provider Business Mailing Address
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Address Line | 11051 HALL RD
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City | UTICA
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State | MI
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Zip | 48317-5735
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Country | US
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Telephone | 586-254-2280
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Fax | 586-254-2280
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. MELANIE MAYCOCK
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Credential |
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Telephone | 586-254-2280
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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 | 506846
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License Number State | MI
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