Healthcare Provider Details

I. General information

NPI: 1770271629
Provider Name (Legal Business Name): UROGYN SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 STONE CREEK BLVD STE 800
FLOWOOD MS
39232-8205
US

IV. Provider business mailing address

778 LIBERTY RD
FLOWOOD MS
39232-9300
US

V. Phone/Fax

Practice location:
  • Phone: 601-914-6450
  • Fax: 601-500-5351
Mailing address:
  • Phone: 769-243-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRIS HARRELL
Title or Position: MANAGING PARTNER
Credential:
Phone: 601-966-7743