Organization
GULF SOUTH SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON SMITH MD (ADMINISTRATOR)
(228) 818-0563
Entity
Organization
Contact information
Practice address
1206 31ST AVE, GULFPORT, MS 39501-1804
(228) 864-0008
Mailing address
1206 31ST AVE, GULFPORT, MS 39501-1804
(228) 864-0008
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
002
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050762
BLUE CROSS BLUE SHIELD
MS
05
—
04608029
—
MS
01
—
362773700
OWCP
MS
01
—
P00064348
MEDICARE RAIL ROAD
MS
Enumeration date
06/04/2006
Last updated
08/22/2020
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