Provider Demographics
NPI:1053649558
Name:POPPS FERRY OUT-PATIENT SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:POPPS FERRY OUT-PATIENT SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERTUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-385-2020
Mailing Address - Street 1:431 BERTUCCI BLVD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2255
Mailing Address - Country:US
Mailing Address - Phone:228-385-2020
Mailing Address - Fax:228-388-9435
Practice Address - Street 1:431 BERTUCCI BLVD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2255
Practice Address - Country:US
Practice Address - Phone:228-385-2020
Practice Address - Fax:228-388-9435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery