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Organization
EAST MISSISSIPPI ENDOSCOPY CENTER LLC
Active
Organization
EAST MISSISSIPPI ENDOSCOPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CRYSTAL BOLER RN (CENTER DIRECTOR)
(601) 485-1131
Entity
Organization
Contact information
Practice address
1926 23RD AVE, MERIDIAN, MS 39301-3107
(601) 485-1131
(601) 485-1336
Mailing address
1926 23RD AVE, MERIDIAN, MS 39301-3107
(601) 485-1131
(601) 485-1336
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050792
STATE MS PROVIDER ID
MS
05
—
00770276
—
MS
01
—
490003787
MEDICARE RAILROAD ID
MS
Enumeration date
10/13/2006
Last updated
12/20/2010
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