Provider Demographics
NPI:1407338338
Name:SELIM SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SELIM SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NIAZY
Authorized Official - Middle Name:MAHMOUD
Authorized Official - Last Name:SELIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD, FACS
Authorized Official - Phone:337-502-8706
Mailing Address - Street 1:215 W PRIEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8450
Mailing Address - Country:US
Mailing Address - Phone:337-502-8706
Mailing Address - Fax:337-210-1271
Practice Address - Street 1:215 W PRIEN LAKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-502-8706
Practice Address - Fax:337-210-1271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD207592261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2388533Medicaid