Healthcare Provider Details

I. General information

NPI: 1821250176
Provider Name (Legal Business Name): NORTHSHORE AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17174 S I-12 SERVICE RD
HAMMOND LA
70403
US

IV. Provider business mailing address

2831 MONROE ST
MANDEVILLE LA
70448-4936
US

V. Phone/Fax

Practice location:
  • Phone: 985-375-1120
  • Fax: 985-542-0733
Mailing address:
  • Phone: 985-375-1111
  • Fax: 985-542-0733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC D GRIENER
Title or Position: OWNER
Credential: MD
Phone: 985-375-1120