Provider Demographics
NPI:1376501064
Name:SOUTH CENTRAL SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:SOUTH CENTRAL SURGICAL CENTER, LLC
Other - Org Name:CENTER FOR SPECIALTY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-277-9668
Mailing Address - Street 1:717 S STATE ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4469
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:717 S STATE ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4469
Practice Address - Country:US
Practice Address - Phone:507-235-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN127628OtherUCARE
MN716185900Medicaid
MN1022719OtherPREFERREDONE
MN5C58SOOtherBLUE CROSS BLUE SHIELD
IA528471Medicaid
139026400OtherUS DEPT OF LABOR
F250619OtherMIDLANDS CHOICE
28772OtherSANFORD
28772OtherSANFORD
MN716185900Medicaid