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General NPI Number Information
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NPI Number | 1528069218
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Entity Type | Organization
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Legal Business Name | NORTHSHORE REGIONAL MEDICAL CENTER DBA THE SURGERY SUITE
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 103 MEDICAL CENTER DR
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City | SLIDELL
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State | LA
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Zip | 70461-5574
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Country | US
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Telephone | 985-646-4466
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Fax | 985-646-5699
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Provider Business Mailing Address
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Address Line | 103 MEDICAL CENTER DR
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City | SLIDELL
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State | LA
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Zip | 70461-5574
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Country | US
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Telephone | 985-646-4466
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Fax | 985-646-5699
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Authorized Official
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Title or Position | DIRECTOR
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Name | ALLISON F. MAESTRI
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Credential | RN
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Telephone | 985-646-4466
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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 | 125
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License Number State | LA
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