Healthcare Provider Details

I. General information

NPI: 1831240928
Provider Name (Legal Business Name): NEW GULF COAST SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3882 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-5803
US

IV. Provider business mailing address

PO BOX 190
OCEAN SPRINGS MS
39566-0190
US

V. Phone/Fax

Practice location:
  • Phone: 228-872-6290
  • Fax:
Mailing address:
  • Phone: 228-872-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number016
License Number StateMS

VIII. Authorized Official

Name: MRS. TAMMI C. ADAMS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 228-818-5521