MEDICARE: GARDNER SURGERY CENTER INC

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	83	LA

General Provider Information

NPI Number	:	1972607489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDNER SURGERY CENTER INC

Provider Business Mailing Address
First Line	:	3101 KILPATRICK BLVD
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5157
Country	:	US
Telephone Number	:	318-322-5506
Fax Number	:	318-322-5916

Provider Business Practice Location Address
First Line	:	3101 KILPATRICK BLVD
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5157
Country	:	US
Telephone Number	:	318-322-5506
Fax Number	:	318-322-5916

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID G GARDNER
Credential	:	DPM
Telephone Number	:	318-322-5506

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	08/12/2010

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