Provider Demographics
NPI:1104858513
Name:DOCTORS OUTPATIENT SURGERY CENTER LLC
Entity Type:Organization
Organization Name:DOCTORS OUTPATIENT SURGERY CENTER LLC
Other - Org Name:SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:G
Authorized Official - Last Name:PORCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-8603
Mailing Address - Street 1:1101 S COLLEGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3038
Mailing Address - Country:US
Mailing Address - Phone:337-233-8603
Mailing Address - Fax:337-234-0341
Practice Address - Street 1:1101 S COLLEGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3038
Practice Address - Country:US
Practice Address - Phone:337-233-8603
Practice Address - Fax:337-234-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203783255261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1356417Medicaid
LA1356417Medicaid