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General NPI Number Information
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NPI Number | 1447225503
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Entity Type | Organization
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Legal Business Name | BAPTIST DESOTO SURGERY CENTER, LP
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 12/20/2010
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Provider Practice Location Address
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Address Line | 391 SOUTHCREST CIRCLE SUITE 100
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4775
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Country | US
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Telephone | 662-349-0910
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Fax | 662-349-0911
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Provider Business Mailing Address
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Address Line | 391 SOUTHCREST CIRCLE SUITE 100
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4775
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Country | US
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Telephone | 662-349-0910
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Fax | 662-349-0911
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ANGELA FERRELL
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Credential | R.N.
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Telephone | 662-349-0910
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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 | 026
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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