Healthcare Provider Details

I. General information

NPI: 1851113567
Provider Name (Legal Business Name): ROYAL SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 FRONT ST STE 2126
VIDALIA LA
71373-2835
US

IV. Provider business mailing address

107 FRONT ST STE 2126
VIDALIA LA
71373-2835
US

V. Phone/Fax

Practice location:
  • Phone: 318-336-2216
  • Fax:
Mailing address:
  • Phone: 318-336-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROYAL SURGERY CENTER
Title or Position: CEO
Credential:
Phone: 318-804-7480