Healthcare Provider Details

I. General information

NPI: 1194536201
Provider Name (Legal Business Name): MERIDIAN ORTHOPAEDIC SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 HIGHWAY 39 N BLDG D
MERIDIAN MS
39301-1078
US

IV. Provider business mailing address

670 LEIGH DR
COLUMBUS MS
39705-3014
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-1012
  • Fax:
Mailing address:
  • Phone: 662-328-1012
  • 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: JAMES LOCKE
Title or Position: CEO
Credential:
Phone: 662-328-1012