Organization
LAUREL SURGERY & ENDOSCOPY CENTER, LLC
Active
Parent organization
LAUREL SURGERY & ENDOSCOPY CENTER, LLC
Other names
Laurel Surgery & Endo Anesthesia
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAUREL SURGERY & ENDOSCOPY CENTER, LLC
Authorized official
LISA BERGIN (ADMINISTRATOR)
(601) 369-2021
Entity
Organization
Contact information
Practice address
1710 W 12TH ST, LAUREL, MS 39440
(601) 369-2021
Mailing address
1710 W 12TH ST, LAUREL, MS 39440-2559
(601) 369-2021
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01224218
—
MS
Enumeration date
11/09/2006
Last updated
04/18/2023
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