Provider Demographics
NPI:1093694044
Name:GAYLORD SURGERY CENTER, LLC
Entity type:Organization
Organization Name:GAYLORD SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO EAST REGION
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KORTH-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-348-0720
Mailing Address - Street 1:7665 S US 131 HWY
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735
Mailing Address - Country:US
Mailing Address - Phone:231-876-7411
Mailing Address - Fax:
Practice Address - Street 1:309 W NORTH ST
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1524
Practice Address - Country:US
Practice Address - Phone:231-876-7411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-02
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty