Healthcare Provider Details

I. General information

NPI: 1528069218
Provider Name (Legal Business Name): NORTHSHORE REGIONAL MEDICAL CENTER DBA THE SURGERY SUITE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MEDICAL CENTER DR
SLIDELL LA
70461-5574
US

IV. Provider business mailing address

103 MEDICAL CENTER DR
SLIDELL LA
70461-5574
US

V. Phone/Fax

Practice location:
  • Phone: 985-646-4466
  • Fax: 985-646-5699
Mailing address:
  • Phone: 985-646-4466
  • Fax: 985-646-5699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number125
License Number StateLA

VIII. Authorized Official

Name: ALLISON F. MAESTRI
Title or Position: DIRECTOR
Credential: RN
Phone: 985-646-4466