Organization
GULF COAST OUTPATIENT SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LEAH ETHRIDGE (ADMINISTRATOR)
(228) 297-0517
Entity
Organization
Contact information
Practice address
2781 CT SENIOR SWITZER DRIVE, SUITE 101, BILOXI, MS 39531
(228) 594-2900
Mailing address
2781 CT SENIOR SWITZER DRIVE, SUITE 101, BILOXI, MS 39531
(228) 594-2900
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
022
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01079220
—
MS
01
—
490000042
MEDICARE PTAN
MS
Enumeration date
07/09/2014
Last updated
07/09/2014
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