NPIMap

Organization Active NPI

Lakeshore Mammography Center PC

  • Specialist
  • Clinton Township, MI
National Provider Identifier
1508936311
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
LAKESHORE MAMMOGRAPHY CENTER PC
Practice address
39200 Garfield Rd
Suite a
Clinton Township, MI 48038-4095
Phone
(586) 228-8000
Fax
(586) 228-7870
NPI assigned
Nov 9, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ms. Judith A Sutherland
Title
President
Phone
(586) 228-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MI Primary

Addresses

Primary practice location

39200 Garfield Rd
Suite a
Clinton Township, MI 48038-4095

Mailing address

39200 Garfield Rd
Suite a
Clinton Township, MI 48038-4095
Phone (586) 228-8000

Other identifiers 3

IdentifierTypeStateIssuer
104361216MedicaidMI
700Q263820OtherMIBCBS & BCN
104341680MedicaidMI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1508936311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39200 GARFIELD RD",
            "address_2": "SUITE A",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480384095",
            "telephone_number": "586-228-8000",
            "fax_number": "586-228-7870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39200 GARFIELD RD",
            "address_2": "SUITE A",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480384095",
            "telephone_number": "586-228-8000",
            "fax_number": "586-228-7870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE MAMMOGRAPHY CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SUTHERLAND",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-228-8000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104361216",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS & BCN",
            "identifier": "700Q263820",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104341680",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.