Healthcare Provider Details

I. General information

NPI: 1235706888
Provider Name (Legal Business Name): SOUTHERN SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 10/17/2021
Certification Date: 10/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 SERVICE RD SW
GRAY LA
70359
US

IV. Provider business mailing address

1633 SAINT CHARLES AVE
NEW ORLEANS LA
70130-4435
US

V. Phone/Fax

Practice location:
  • Phone: 985-223-3132
  • Fax:
Mailing address:
  • Phone: 504-680-8383
  • Fax: 504-680-8383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NATHANIEL GRAFF
Title or Position: MANAGER
Credential:
Phone: 504-234-5917