Provider Demographics
NPI:1649499740
Name:LAKELAND SURGICAL CLINIC PLLC
Entity type:Organization
Organization Name:LAKELAND SURGICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LOFTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-982-3202
Mailing Address - Street 1:971 LAKELAND DR STE 1460
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4621
Mailing Address - Country:US
Mailing Address - Phone:601-982-3202
Mailing Address - Fax:601-982-3259
Practice Address - Street 1:971 LAKELAND DR STE 1460
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4621
Practice Address - Country:US
Practice Address - Phone:601-982-3202
Practice Address - Fax:601-982-3259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty