Organization
NEW CEDAR LAKE SURGERY CENTER, LLC
Active
Other names
The Surgery Center at Cedar Lake
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES J WILSON M.D. (OWNER AND DIRECTOR)
(228) 702-2000
Entity
Organization
Contact information
Practice address
1720 MEDICAL PARK DR # B, BILOXI, MS 39532-2131
(228) 702-2000
(228) 702-2019
Mailing address
1720 MEDICAL PARK DR # B, BILOXI, MS 39532-2131
(228) 702-2000
(228) 314-2589
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
004
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770025
—
MS
Enumeration date
10/04/2006
Last updated
02/20/2017
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