Healthcare Provider Details

I. General information

NPI: 1891962833
Provider Name (Legal Business Name): SURGERY CENTER OF WEST MONROE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 REGENCY PL
WEST MONROE LA
71291-4452
US

IV. Provider business mailing address

1804 N 7TH ST
WEST MONROE LA
71291-4414
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-4888
  • Fax: 318-325-7715
Mailing address:
  • Phone: 318-325-2610
  • Fax: 318-325-7715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number111
License Number StateLA

VIII. Authorized Official

Name: DR. RAYMOND E. HAIK JR.
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 318-325-2610