Organization
CRESCENT CITY SURGICAL CENTRE DIAGNOSTICS, LLC
Active
Organization
CRESCENT CITY SURGICAL CENTRE DIAGNOSTICS, LLC
Active
Parent organization
CRESCENT CITY SURGICAL CENTRE DIAGNOSTICS, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CRESCENT CITY SURGICAL CENTRE DIAGNOSTICS, LLC
Authorized official
WILLIAM LAWRENCE BOUCHILLON JR. MR. (CEO)
(662) 803-6086
Entity
Organization
Contact information
Practice address
735 VETERANS MEMORIAL DR, KOSCIUSKO, MS 39090-3854
(662) 803-6086
(504) 504-5211
Mailing address
735 VETERANS MEMORIAL DR, KOSCIUSKO, MS 39090-3854
(662) 803-6086
(504) 504-5211
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25D2346670
CLIA
MS
Enumeration date
07/28/2026
Last updated
07/28/2026
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