Organization
SOUTHERN EYE SURGERY CENTER LLC
Active
Organization
SOUTHERN EYE SURGERY CENTER LLC
Active
Other names
Southern Eye Center of Excellence
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYNN B MCMAHAN M.D. (PRESIDENT)
(601) 264-3937
Entity
Organization
Contact information
Practice address
1420 S 28TH AVE, HATTIESBURG, MS 39402-3107
(601) 264-3937
(601) 264-5930
Mailing address
1420 S 28TH AVE, HATTIESBURG, MS 39402-3107
(601) 264-3937
(601) 264-5930
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
010
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770066
—
MS
01
—
512G490003
MEDICARE PTAN FOR SOUTHERN EYE SURGERY CENTER LLC
MS
Enumeration date
01/31/2008
Last updated
01/15/2009
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