Healthcare Provider Details

I. General information

NPI: 1396726097
Provider Name (Legal Business Name): MISSISSIPPI SURGICAL CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 N STATE ST
JACKSON MS
39202-1658
US

IV. Provider business mailing address

1421 N STATE ST
JACKSON MS
39202-1658
US

V. Phone/Fax

Practice location:
  • Phone: 601-353-8000
  • Fax: 601-948-2507
Mailing address:
  • Phone: 601-353-8000
  • Fax: 601-948-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number007
License Number StateMS

VIII. Authorized Official

Name: MR. RICHARD L SHARFF JR.
Title or Position: VICE PRESIDENT
Credential:
Phone: 205-545-2572