Healthcare Provider Details

I. General information

NPI: 1427138452
Provider Name (Legal Business Name): COMMUNITY SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 DEWEY ST
LUCEDALE MS
39452-5707
US

IV. Provider business mailing address

PO BOX 1007
LUCEDALE MS
39452-1007
US

V. Phone/Fax

Practice location:
  • Phone: 601-766-0308
  • Fax: 601-766-0309
Mailing address:
  • Phone: 601-947-1326
  • Fax: 601-947-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHY FENDER
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-947-8181