Organization
EAST MISSISSIPPI ENDOSCOPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CRYSTAL BOLER RN (CENTER DIRECTOR)
(601) 485-1131
Entity
Organization
Contact information
Practice address
1926 23RD AVE, MERIDIAN, MS 39301-3107
(601) 485-1131
(601) 485-1336
Mailing address
1926 23RD AVE, MERIDIAN, MS 39301-3107
(601) 485-1131
(601) 485-1336
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050792
STATE MS PROVIDER ID
MS
05
—
00770276
—
MS
01
—
490003787
MEDICARE RAILROAD ID
MS
Enumeration date
10/13/2006
Last updated
12/20/2010
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