Healthcare Provider Details

I. General information

NPI: 1053649558
Provider Name (Legal Business Name): POPPS FERRY OUT-PATIENT SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 BERTUCCI BLVD
BILOXI MS
39531-2255
US

IV. Provider business mailing address

431 BERTUCCI BLVD
BILOXI MS
39531-2255
US

V. Phone/Fax

Practice location:
  • Phone: 228-385-2020
  • Fax: 228-388-9435
Mailing address:
  • Phone: 228-385-2020
  • Fax: 228-388-9435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY E BERTUCCI
Title or Position: OWNER
Credential: MD
Phone: 228-385-2020