Healthcare Provider Details

I. General information

NPI: 1073519195
Provider Name (Legal Business Name): ALLIANCE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 HOUMA BLVD STE 200
METAIRIE LA
70006-4115
US

IV. Provider business mailing address

3717 HOUMA BLVD STE 200
METAIRIE LA
70006-4101
US

V. Phone/Fax

Practice location:
  • Phone: 504-885-7676
  • Fax: 504-885-7659
Mailing address:
  • Phone: 504-885-7676
  • Fax: 504-885-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number461683
License Number StateLA

VIII. Authorized Official

Name: TIFFANY VIDRINE FONTENOT
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 504-885-7676