MEDICARE: GULF COAST OUTPATIENT SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	022	MS

General Provider Information

NPI Number	:	1740385632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST OUTPATIENT SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	2781 C T SWITZER SR DR
Second Line	:	SUITE 101
City	:	BILOXI
State	:	MS
Zip	:	39531-4536
Country	:	US
Telephone Number	:	228-594-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2781 C.T. SWITZER SR DIRVE
Second Line	:	SUITE 101
City	:	BILOXI
State	:	MS
Zip	:	39531-4535
Country	:	US
Telephone Number	:	228-594-2900
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	MARY HUFFMANN
Credential	:
Telephone Number	:	228-594-2904

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	06/06/2011

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