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General NPI Number Information
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NPI Number | 1972223394
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Entity Type | Organization
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Legal Business Name | BRONSON AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 08/29/2022
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 6263 BEATRICE DR
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City | KALAMAZOO
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State | MI
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Zip | 49009
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Country | US
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Telephone | 269-352-8911
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Fax | 269-341-7519
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Provider Business Mailing Address
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Address Line | 6263 BEATRICE DR
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City | KALAMAZOO
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State | MI
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Zip | 49009-9556
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Country | US
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Telephone | 269-352-8911
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Fax | 269-308-7011
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. KENNETH HAMMER
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Credential | RN
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Telephone | 269-352-8911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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