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General NPI Number Information
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NPI Number | 1457960536
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Entity Type | Organization
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Legal Business Name | LAKE GEORGE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 6245 N OLD 27 STE A10
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City | FREMONT
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State | IN
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Zip | 46737-8707
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Country | US
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Telephone | 517-462-8283
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Fax |
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Provider Business Mailing Address
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Address Line | 302 N FISKE RD
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City | COLDWATER
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State | MI
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Zip | 49036-9138
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Country | US
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Telephone | 517-462-8283
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Fax |
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Authorized Official
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Title or Position | RN ADMINISTRATOR
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Name | KATHY MECCIA
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Credential | RNBC, BSN, CNOR
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Telephone | 517-462-8283
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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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