Provider Demographics
NPI:1992735286
Name:CASTLEMAN SURGERY CENTER, LLC
Entity type:Organization
Organization Name:CASTLEMAN SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:734-281-0100
Mailing Address - Street 1:14050 DIX TOLEDO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2501
Mailing Address - Country:US
Mailing Address - Phone:734-281-0100
Mailing Address - Fax:734-283-4839
Practice Address - Street 1:14050 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2501
Practice Address - Country:US
Practice Address - Phone:734-281-0100
Practice Address - Fax:734-283-4839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301027659261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3398300Medicaid
MI=========OtherFEDERAL TAX ID NUMBER
MI0H27005Medicare ID - Type UnspecifiedPROVIDER NUMBER