Provider Demographics
NPI:1013158948
Name:WESTSIDE SURGERY CENTER, LLC
Entity type:Organization
Organization Name:WESTSIDE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-384-2200
Mailing Address - Street 1:P.O. BOX 1068
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-1068
Mailing Address - Country:US
Mailing Address - Phone:912-384-2200
Mailing Address - Fax:912-383-7992
Practice Address - Street 1:314 WESTSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-0314
Practice Address - Country:US
Practice Address - Phone:912-384-2200
Practice Address - Fax:912-383-7992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA794275173AMedicaid
GA11C0001335Medicare Oscar/Certification
GAG37221Medicare UPIN
GA202G498949Medicare PIN