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Organization
GULF COAST OUTPATIENT SURGERY CENTER, LLC
Active
Organization
GULF COAST OUTPATIENT SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LEAH ETHRIDGE (ADMINISTRATOR)
(228) 297-0517
Entity
Organization
Contact information
Practice address
2781 CT SENIOR SWITZER DRIVE, SUITE 101, BILOXI, MS 39531
(228) 594-2900
Mailing address
2781 CT SENIOR SWITZER DRIVE, SUITE 101, BILOXI, MS 39531
(228) 594-2900
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
022
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01079220
—
MS
01
—
490000042
MEDICARE PTAN
MS
Enumeration date
07/09/2014
Last updated
07/09/2014
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