Provider Demographics
NPI:1629300512
Name:BELLEVUE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:BELLEVUE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN, BELLEVUE SURGERY CE
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETLEY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:SITZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-466-0474
Mailing Address - Street 1:P.O. BOX 18260
Mailing Address - Street 2:BELLEVUE SURGERY CENTER, LLC
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-8260
Mailing Address - Country:US
Mailing Address - Phone:601-450-7249
Mailing Address - Fax:601-450-7250
Practice Address - Street 1:7125 HIGHWAY 98
Practice Address - Street 2:BELLEVUE SURGERY CENTER, LLC
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-450-7249
Practice Address - Fax:601-450-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical