Provider Demographics
NPI:1184806028
Name:PONTCHARTRAIN SURGERY CENTER LLC
Entity type:Organization
Organization Name:PONTCHARTRAIN SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SAXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-234-9700
Mailing Address - Street 1:4407 HWY 190 SERVICE RD, EAST
Mailing Address - Street 2:STE. 200
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-234-9700
Mailing Address - Fax:985-234-9700
Practice Address - Street 1:4407 HWY 190 SERVICE RD, EAST
Practice Address - Street 2:STE. 200
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-234-9700
Practice Address - Fax:985-234-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical