Organization
LAUREL SURGERY & ENDOSCOPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA BERGIN (ADMINISTRATOR)
(601) 369-2021
Entity
Organization
Contact information
Practice address
1710 W 12TH ST, LAUREL, MS 39440-2559
(601) 369-2021
Mailing address
1710 W 12TH ST, LAUREL, MS 39440-2559
(601) 369-2021
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
025
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050710
BLUE CROSS BLUE SHIELD
MS
05
—
01357572
—
MS
Enumeration date
07/05/2006
Last updated
04/18/2023
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