Healthcare Provider Details

I. General information

NPI: 1972607489
Provider Name (Legal Business Name): GARDNER SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 KILPATRICK BLVD
MONROE LA
71201-5157
US

IV. Provider business mailing address

3101 KILPATRICK BLVD
MONROE LA
71201-5157
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-5506
  • Fax: 318-322-5916
Mailing address:
  • Phone: 318-322-5506
  • Fax: 318-322-5916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number83
License Number StateLA

VIII. Authorized Official

Name: DR. DAVID G GARDNER
Title or Position: PRESIDENT
Credential: DPM
Phone: 318-322-5506