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General NPI Number Information
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NPI Number | 1629300512
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Entity Type | Organization
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Legal Business Name | BELLEVUE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 7125 HIGHWAY 98 BELLEVUE SURGERY CENTER, LLC
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City | HATTIESBURG
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State | MS
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Zip | 39402
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Country | US
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Telephone | 601-450-7249
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Fax | 601-450-7250
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Provider Business Mailing Address
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Address Line | P.O. BOX 18260 BELLEVUE SURGERY CENTER, LLC
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City | HATTIESBURG
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State | MS
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Zip | 39404-8260
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Country | US
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Telephone | 601-450-7249
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Fax | 601-450-7250
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Authorized Official
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Title or Position | BOARD CHAIRMAN, BELLEVUE SURGERY CE
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Name | DR. BRETLEY TODD SITZMAN
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Credential | M.D.
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Telephone | 601-466-0474
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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 |
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License Number State |
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