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General NPI Number Information
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NPI Number | 1437320231
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Entity Type | Organization
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Legal Business Name | GULF SOUTH MEDICAL & SURGICAL INSTITUTE, INC.
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 600 N HIGHWAY 190 STE 201
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City | COVINGTON
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State | LA
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Zip | 70433-5083
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Country | US
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Telephone | 985-892-5497
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Fax | 985-892-9088
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Provider Business Mailing Address
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Address Line | PO BOX 459
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City | KENNER
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State | LA
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Zip | 70063-0459
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Country | US
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Telephone | 504-471-3100
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Fax | 504-471-3109
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/OWNER
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Name | DR. GEORGE ALLEN FARBER SR.
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Credential | MD
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Telephone | 504-471-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 207NI0002X
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License Number State | LA
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