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Organization
DESOTO SURGERY CLINIC LLC
Active
Organization
DESOTO SURGERY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL E FOSTER MD (MEDICAL DIRECTOR)
(662) 536-1545
Entity
Organization
Contact information
Practice address
7580 CLARINGTON CV, SOUTHAVEN, MS 38671
(662) 536-1545
(662) 536-8220
Mailing address
7580 CLARINGTON CV, SOUTHAVEN, MS 38671
(662) 536-1545
(662) 536-8220
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08232036
—
MS
Enumeration date
08/01/2006
Last updated
03/14/2008
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