Healthcare Provider Details

I. General information

NPI: 1184806028
Provider Name (Legal Business Name): PONTCHARTRAIN SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4407 HWY 190 SERVICE RD, EAST STE. 200
COVINGTON LA
70433
US

IV. Provider business mailing address

4407 HWY 190 SERVICE RD, EAST STE. 200
COVINGTON LA
70433
US

V. Phone/Fax

Practice location:
  • Phone: 985-234-9700
  • Fax: 985-234-9700
Mailing address:
  • Phone: 985-234-9700
  • Fax: 985-234-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberPENDING
License Number State

VIII. Authorized Official

Name: PEGGY C. SAXON
Title or Position: ADMINISTRATOR
Credential:
Phone: 985-234-9700