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Organization
NEW CEDAR LAKE SURGERY CENTER, LLC
Active
Organization
NEW CEDAR LAKE SURGERY CENTER, LLC
Active
Other names
The Surgery Center at Cedar Lake
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES J WILSON M.D. (OWNER AND DIRECTOR)
(228) 702-2000
Entity
Organization
Contact information
Practice address
1720 MEDICAL PARK DR # B, BILOXI, MS 39532-2131
(228) 702-2000
(228) 702-2019
Mailing address
1720 MEDICAL PARK DR # B, BILOXI, MS 39532-2131
(228) 702-2000
(228) 314-2589
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
004
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770025
—
MS
Enumeration date
10/04/2006
Last updated
02/20/2017
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