Organization
GREEN CLINIC SURGICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES MCCLUNG (ADMINISTRATOR)
(318) 232-7186
Entity
Organization
Contact information
Practice address
1200 S FARMERVILLE ST, RUSTON, LA 71270-5941
(318) 232-7148
(318) 232-1092
Mailing address
PO BOX 1586, RUSTON, LA 71273-1586
(318) 232-7148
(318) 232-1092
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
87
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1563951
—
LA
01
—
20063
BCBS PROVIDER NO.
LA
Enumeration date
10/12/2006
Last updated
08/22/2020
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