Provider Demographics
NPI:1154867562
Name:UROLOGIC AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:UROLOGIC AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-432-0700
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-0829
Mailing Address - Country:US
Mailing Address - Phone:662-377-7100
Mailing Address - Fax:662-377-5736
Practice Address - Street 1:499 GLOSTER CREEK VLG STE B8
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4633
Practice Address - Country:US
Practice Address - Phone:662-432-0700
Practice Address - Fax:662-846-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty