Provider Demographics
NPI:1578808069
Name:HILLCREST SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:HILLCREST SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-296-2800
Mailing Address - Street 1:PO BOX 16100
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-6100
Mailing Address - Country:US
Mailing Address - Phone:478-304-1268
Mailing Address - Fax:800-886-8895
Practice Address - Street 1:1110 HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3687
Practice Address - Country:US
Practice Address - Phone:478-296-2800
Practice Address - Fax:478-296-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical