MEDICARE: CASTLEMAN SURGERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	4301027659	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992735286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTLEMAN SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	14050 DIX TOLEDO RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-2501
Country	:	US
Telephone Number	:	734-281-0100
Fax Number	:	734-283-4839

Provider Business Practice Location Address
First Line	:	14050 DIX TOLEDO RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-2501
Country	:	US
Telephone Number	:	734-281-0100
Fax Number	:	734-283-4839

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LINDA PHILLIPS
Credential	:	R.N.
Telephone Number	:	734-281-0100

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	02/03/2021

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