Healthcare Provider Details

I. General information

NPI: 1932207669
Provider Name (Legal Business Name): EYE SURGICAL CENTER OF MISSISSIPPI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 RIVER OAKS DR
FLOWOOD MS
39232-9595
US

IV. Provider business mailing address

1053 RIVER OAKS DR
FLOWOOD MS
39232-9595
US

V. Phone/Fax

Practice location:
  • Phone: 601-969-1430
  • Fax: 601-709-2117
Mailing address:
  • Phone: 601-969-1430
  • Fax: 601-709-2117

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: DR. LESLIE BRANNON ADEN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 601-969-1430