Organization
SOUTHERN EYE SURGERY CENTER LLC
Active
Other names
Anesthesia
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN B MCMAHAN M.D. (MANAGING MEMBER/PRESIDENT)
(601) 705-0078
Entity
Organization
Contact information
Practice address
1420 S 28TH AVE, HATTIESBURG, MS 39402-3107
(601) 264-3937
Mailing address
1420 S 28TH AVE, HATTIESBURG, MS 39402-3107
(601) 264-3937
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
010
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
512G700151
MEDICARE PTAN
MS
Enumeration date
07/22/2008
Last updated
08/25/2008
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