Provider Demographics
NPI:1164472031
Name:TUPELO SURGERY CENTER, L.L.C.
Entity Type:Organization
Organization Name:TUPELO SURGERY CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-844-3555
Mailing Address - Street 1:3353 N GLOSTER ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-9735
Mailing Address - Country:US
Mailing Address - Phone:662-407-0334
Mailing Address - Fax:662-840-5614
Practice Address - Street 1:3353 N GLOSTER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-9735
Practice Address - Country:US
Practice Address - Phone:662-407-0334
Practice Address - Fax:662-840-5614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0502562261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0770601Medicaid
MS0770601Medicaid
MSB66205Medicare UPIN