# DESOTO SURGERY CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528074184
- **Authorized official:** MICHAEL E FOSTER MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (662) 536-1545

## Contact information

- **Practice address:** 7580 CLARINGTON CV, SOUTHAVEN, MS 38671
- **Practice address phone:** (662) 536-1545
- **Practice address fax:** (662) 536-8220
- **Mailing address:** 7580 CLARINGTON CV, SOUTHAVEN, MS 38671
- **Mailing address phone:** (662) 536-1545
- **Mailing address fax:** (662) 536-8220

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/01/2006
- **Last updated:** 03/14/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 08232036 | — | MS |