Provider Demographics
NPI:1891962833
Name:SURGERY CENTER OF WEST MONROE
Entity Type:Organization
Organization Name:SURGERY CENTER OF WEST MONROE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAIK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-325-2610
Mailing Address - Street 1:1804 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-4414
Mailing Address - Country:US
Mailing Address - Phone:318-325-2610
Mailing Address - Fax:318-325-7715
Practice Address - Street 1:102 REGENCY PL
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4452
Practice Address - Country:US
Practice Address - Phone:318-322-4888
Practice Address - Fax:318-325-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA111261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1142565Medicaid