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General NPI Number Information
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NPI Number | 1073519195
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Entity Type | Organization
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Legal Business Name | ALLIANCE SURGERY CENTER LLC
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 3717 HOUMA BLVD STE 200
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City | METAIRIE
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State | LA
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Zip | 70006-4115
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Country | US
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Telephone | 504-885-7676
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Fax | 504-885-7659
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Provider Business Mailing Address
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Address Line | 3717 HOUMA BLVD STE 200
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City | METAIRIE
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State | LA
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Zip | 70006-4101
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Country | US
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Telephone | 504-885-7676
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Fax | 504-885-7659
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TIFFANY VIDRINE FONTENOT
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Credential | RN
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Telephone | 504-885-7676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | 461683
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License Number State | LA
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