Healthcare Provider Details

I. General information

NPI: 1891790887
Provider Name (Legal Business Name): CORINTH SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ALCORN DR STE C
CORINTH MS
38834-9067
US

IV. Provider business mailing address

13740 CYPRESS TERRACE CIR STE 501-503
FORT MYERS FL
33907-8827
US

V. Phone/Fax

Practice location:
  • Phone: 662-293-2000
  • Fax: 662-665-0857
Mailing address:
  • Phone: 239-274-1000
  • Fax: 239-274-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number012
License Number StateMS

VIII. Authorized Official

Name: MS. ANGELA JACKSON
Title or Position: ADMINISTRATOR
Credential: R.N., B.S.N.
Phone: 662-293-2000