Healthcare Provider Details

I. General information

NPI: 1548192339
Provider Name (Legal Business Name): SPECIALTY SURGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11414 LAKE SHERWOOD AVE N STE B
BATON ROUGE LA
70816-0406
US

IV. Provider business mailing address

11414 LAKE SHERWOOD AVE N STE B
BATON ROUGE LA
70816-0406
US

V. Phone/Fax

Practice location:
  • Phone: 225-532-4058
  • Fax: 225-659-8031
Mailing address:
  • Phone: 225-532-4058
  • Fax: 225-659-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES W MOCK
Title or Position: CEO
Credential: CPA
Phone: 225-532-4058