Provider Demographics
NPI:1528323185
Name:ALL SEASONS SKIN AND SURGERY CENTER
Entity type:Organization
Organization Name:ALL SEASONS SKIN AND SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-797-7546
Mailing Address - Street 1:6300 STATE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2730
Mailing Address - Country:US
Mailing Address - Phone:989-797-7546
Mailing Address - Fax:989-797-6007
Practice Address - Street 1:6300 STATE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2730
Practice Address - Country:US
Practice Address - Phone:989-797-7546
Practice Address - Fax:989-797-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012096MI207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM65490Medicare PIN