Provider Demographics
NPI:1386670511
Name:HATTIESBURG AMBULATORY SURGERY CENTER LP
Entity Type:Organization
Organization Name:HATTIESBURG AMBULATORY SURGERY CENTER LP
Other - Org Name:SOUTH MISSISSIPPI SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BUSINESS OFFICE SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:PO BOX 849823
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-9823
Mailing Address - Country:US
Mailing Address - Phone:601-296-3800
Mailing Address - Fax:601-296-3810
Practice Address - Street 1:39 FRANKLIN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1366
Practice Address - Country:US
Practice Address - Phone:601-296-3800
Practice Address - Fax:601-296-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS024261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04275391Medicaid
P00172366OtherMEDICARE RAILROAD