Woodbridge Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

396814 Issued in MI

Legal business name

WOODBRIDGE CENTER LLC

Practice address

7901 Angling Rd
Portage, MI 49024-0714

Phone

(269) 324-8406

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Brij Dewan, MD

Title

President

Phone

(269) 385-9900

Specialties & licenses 2

Addresses

Other names 1

• Endoscopy and Surgery Center at Woodbridge Hills Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Listed as

Woodbridge Center LLCCCN 23C0001028

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rick William Tiller, D.P.M.

  • Podiatrist
  • Kalamazoo, MI
  • NPI 1134190614
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326844800000",
    "number": "1508978990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5943 STADIUM DR",
            "address_2": "SUITE 3",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490093016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7901 ANGLING RD",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490240714",
            "telephone_number": "269-324-8406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBRIDGE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-01-18",
        "status": "A",
        "authorized_official_last_name": "DEWAN",
        "authorized_official_first_name": "BRIJ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "269-385-9900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MI",
            "license": "396814",
            "primary": true
        },
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Endoscopy and Surgery Center at Woodbridge Hills",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Erik Matthew Wittrup, LMSW
• Diane Witzel, LMSW
• Grace Josephine Wojdak, LPC
• Kari Ellen Wolf, PA-C
• Kerri Rochelle Wood
• Woodbridge Dental Care, PLLC
• Aubrie Elizabeth Wooden, LMSW
• Woodward Detroit CVS LLC
• Christina Jo Woytal, PT
• Jody Lynn Wrathall, D.D.S., M.S.

• Ambulatory Surgical Clinic/Center in Portage, MI
• Providers in Portage, MI by specialty
• Ambulatory Surgical Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.