Organization
ST DOMINIC AMBULATORY SURGERY CENTER L L C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD YELVERTON M.D. (MEDICAL DIRECTOR)
(601) 984-8800
Entity
Organization
Contact information
Practice address
970 LAKELAND DR, SUITE 15, JACKSON, MS 39216-4601
(601) 984-8800
(601) 321-8670
Mailing address
970 LAKELAND DR., SUITE 15, JAKCSON, MS 39216
(601) 984-8800
(601) 321-8670
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
011
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0770362
—
MS
Enumeration date
02/02/2006
Last updated
06/16/2010
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