Healthcare Provider Details

I. General information

NPI: 1073946216
Provider Name (Legal Business Name): MADISON PHYSICIAN SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 LAKELAND DR
FLOWOOD MS
39232-9583
US

IV. Provider business mailing address

4510 LAKELAND DR
FLOWOOD MS
39232-9583
US

V. Phone/Fax

Practice location:
  • Phone: 601-944-1717
  • Fax: 601-944-9780
Mailing address:
  • Phone: 601-605-5393
  • Fax: 601-605-6393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MEREDITH GORE WARF
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-605-5393