=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518246081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SURGERY CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2011
-----------------------------------------------------
Last Update Date | 08/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2466 FLOWOOD DR # A
-----------------------------------------------------
City | FLOWOOD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39232-9019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-326-9393
-----------------------------------------------------
Fax | 601-326-9394
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2466 FLOWOOD DR # A
-----------------------------------------------------
City | FLOWOOD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39232-9019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-326-9393
-----------------------------------------------------
Fax | 601-326-9394
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AO-DIRECTOR OF CREDENTIALLING
-----------------------------------------------------
Name | KRISTY MUSIC
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-465-7377
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------