Healthcare Provider Details

I. General information

NPI: 1497090740
Provider Name (Legal Business Name): PONTCHARTRAIN SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4407 HIGHWAY 190 EAST SERVICE RD STE 200
COVINGTON LA
70433-4957
US

IV. Provider business mailing address

4407 HIGHWAY 190 EAST SERVICE RD STE 200
COVINGTON LA
70433-4972
US

V. Phone/Fax

Practice location:
  • Phone: 985-234-9700
  • Fax: 985-234-9706
Mailing address:
  • Phone: 985-234-9700
  • Fax: 985-234-9706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number157
License Number StateLA

VIII. Authorized Official

Name: LISA SALMON
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 985-234-9700