Organization
SURGICAL SPECIALTY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KANDI R MOORE RN, CNOR (ADMINISTRATOR)
(318) 631-2525
Entity
Organization
Contact information
Practice address
1500 LINE AVE, SUITE 204, SHREVEPORT, LA 71101-4639
(318) 629-5001
(318) 629-5020
Mailing address
1500 LINE AVE, SUITE 204, SHREVEPORT, LA 71101-4639
(318) 629-5001
(318) 629-5020
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
80
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1478334
—
LA
Enumeration date
07/08/2006
Last updated
03/31/2008
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