Provider Demographics
NPI:1891790887
Name:CORINTH SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CORINTH SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:662-293-2000
Mailing Address - Street 1:13740 CYPRESS TERRACE CIR
Mailing Address - Street 2:STE 501-503
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8827
Mailing Address - Country:US
Mailing Address - Phone:239-274-1000
Mailing Address - Fax:239-274-1001
Practice Address - Street 1:401 ALCORN DR
Practice Address - Street 2:STE C
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9067
Practice Address - Country:US
Practice Address - Phone:662-293-2000
Practice Address - Fax:662-665-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS012261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4287023Medicaid
TN3141695OtherBC/BS OF TN
MS00770360Medicaid