Provider Demographics
NPI:1821250176
Name:NORTHSHORE AMBULATORY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:NORTHSHORE AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-375-1120
Mailing Address - Street 1:2831 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-4936
Mailing Address - Country:US
Mailing Address - Phone:985-375-1111
Mailing Address - Fax:985-542-0733
Practice Address - Street 1:17174 S I-12 SERVICE RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-375-1120
Practice Address - Fax:985-542-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery