Organization
MAE PHYSICIANS SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARLA GLAZE (ADMINISTRATOR)
(601) 968-1790
Entity
Organization
Contact information
Practice address
1190 N STATE ST, STE 102, JACKSON, MS 39202-2413
(601) 968-1790
(601) 292-4531
Mailing address
PO BOX 12673, JACKSON, MS 39236-2673
(601) 968-1790
(601) 292-4531
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
11/07/2005
Last updated
04/10/2014
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