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General NPI Number Information
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NPI Number | 1255303517
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Entity Type | Organization
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Legal Business Name | ST DOMINIC AMBULATORY SURGERY CENTER L L C
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 970 LAKELAND DR SUITE 15
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City | JACKSON
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State | MS
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Zip | 39216-4601
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Country | US
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Telephone | 601-984-8800
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Fax | 601-321-8670
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Provider Business Mailing Address
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Address Line | 970 LAKELAND DR. SUITE 15
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City | JAKCSON
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State | MS
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Zip | 39216
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Country | US
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Telephone | 601-984-8800
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Fax | 601-321-8670
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RICHARD YELVERTON
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Credential | M.D.
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Telephone | 601-984-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 011
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License Number State | MS
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