Healthcare Provider Details

I. General information

NPI: 1427890466
Provider Name (Legal Business Name): MISSISSIPPI BAPTIST SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BAPTIST DR
MADISON MS
39110-2009
US

IV. Provider business mailing address

401 BAPTIST DR
MADISON MS
39110-2009
US

V. Phone/Fax

Practice location:
  • Phone: 901-227-5233
  • Fax:
Mailing address:
  • Phone: 901-227-5233
  • 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: MR. GREGORY M DUCKETT
Title or Position: CLO
Credential:
Phone: 901-227-5233