NPIMap

Organization Active NPI

Prime Healthcare Services-Port Huron, LLC

  • Ambulatory Surgical Clinic/Center
  • Fort Gratiot, MI
National Provider Identifier
1134586852
Registry record updated Jan 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
746818 Issued in MI
Legal business name
PRIME HEALTHCARE SERVICES-PORT HURON, LLC
Practice address
4190 24TH Ave
Fort Gratiot, MI 48059-3882
Phone
(810) 989-7700
NPI assigned
Jan 26, 2016
Organization subpart
Yes
Parent organization
PRIME HEALTHCARE SERVICES-PORT HURON, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 26, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christopher Doan
Title
Chief Compliance Counsel
Phone
(909) 235-4307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 746818 MI Primary

Addresses

Primary practice location

4190 24TH Ave
Fort Gratiot, MI 48059-3882

Mailing address

4190 24TH Ave
Fort Gratiot, MI 48059-3882
Phone (810) 989-7700

Other names 1

  • Lakeshore Surgery Center, LLP Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Prime Healthcare Services-Port Huron LLC5 organizations share this tax ID, including this one
Part of
Prime Healthcare Services-Port Huron LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1453766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453766400000",
    "number": "1134586852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4190 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593882",
            "telephone_number": "810-989-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 24TH AVE",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593882",
            "telephone_number": "810-989-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES-PORT HURON, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIME HEALTHCARE SERVICES-PORT HURON, LLC",
        "enumeration_date": "2016-01-26",
        "last_updated": "2016-01-26",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE COUNSEL",
        "authorized_official_telephone_number": "909-235-4307"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MI",
            "license": "746818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeshore Surgery Center, LLP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Gratiot, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.