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General NPI Number Information
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NPI Number | 1386670511
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Entity Type | Organization
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Legal Business Name | HATTIESBURG AMBULATORY SURGERY CENTER LP
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 39 FRANKLIN RD SUITE 100
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City | HATTIESBURG
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State | MS
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Zip | 39402-1366
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Country | US
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Telephone | 601-296-3800
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Fax | 601-296-3810
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Provider Business Mailing Address
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Address Line | PO BOX 849823
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City | DALLAS
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State | TX
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Zip | 75284-9823
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Country | US
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Telephone | 601-296-3800
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Fax | 601-296-3810
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Authorized Official
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Title or Position | DIRECTOR, BUSINESS OFFICE SUPPORT
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Name | LAURIE HOLTSFORD
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Credential |
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Telephone | 615-465-7466
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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 | 024
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License Number State | MS
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