Healthcare Provider Details

I. General information

NPI: 1386417806
Provider Name (Legal Business Name): MISSISSIPPI ASC JV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 BAPTIST CIR STE 401
MADISON MS
39110-2028
US

IV. Provider business mailing address

1026 BAPTIST CIR STE 401
MADISON MS
39110-2028
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-4091
  • Fax: 601-354-7264
Mailing address:
  • Phone: 601-981-4091
  • Fax: 601-981-5039

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: LAURA BARTON
Title or Position: DIRECTOR
Credential:
Phone: 601-981-4091