MEDICARE: SURGERY CENTER OF HAMMOND, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	104	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356344410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGERY CENTER OF HAMMOND, LLC

Provider Business Mailing Address
First Line	:	42144 VETERANS AVE
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1427
Country	:	US
Telephone Number	:	985-542-6344
Fax Number	:

Provider Business Practice Location Address
First Line	:	42144 VETERANS AVE
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1427
Country	:	US
Telephone Number	:	985-542-6344
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JENNIFER K GRECO
Credential	:
Telephone Number	:	985-542-6344

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/04/2007

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