Organization Active NPI

Livonia Outpatient Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Livonia, MI
National Provider Identifier
1639476377
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
LIVONIA OUTPATIENT SURGERY CENTER, LLC
Practice address
33400 6 Mile Rd
Suite B
Livonia, MI 48152-3143
Phone
(810) 623-1482
NPI assigned
Feb 15, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Authorized official

Name
Mr. Gregory Nodland
Title
Chief Executive Officer
Phone
(734) 452-7111

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary
Ophthalmologic Surgery Clinic/Center 261QS0132X

Addresses

Primary practice location

33400 6 Mile Rd
Suite B
Livonia, MI 48152-3143

Mailing address

33400 6 Mile Rd
Suite B
Livonia, MI 48152-3143
Phone (347) 452-7111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110517000842 MI Part B Supplier - Ambulatory Surgical Center 1254517725 Practice locations: Livonia, MI

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Livonia Outpatient Surgery Center LLCCCN 23C0001115
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

33400 6 Mile Rd
Ste B
Livonia, MI 48152
Phone (734) 452-7111

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1297728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721088000000",
    "number": "1639476377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33400 6 MILE RD",
            "address_2": "SUITE B",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481523143",
            "telephone_number": "347-452-7111",
            "fax_number": "734-452-7129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33400 6 MILE RD",
            "address_2": "SUITE B",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481523143",
            "telephone_number": "810-623-1482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVONIA OUTPATIENT SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-15",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A",
        "authorized_official_last_name": "NODLAND",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "734-452-7111",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; 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.