Organization
CORINTH SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANGELA JACKSON R.N., B.S.N. (ADMINISTRATOR)
(662) 293-2000
Entity
Organization
Contact information
Practice address
401 ALCORN DR, STE C, CORINTH, MS 38834-9067
(662) 293-2000
(662) 665-0857
Mailing address
13740 CYPRESS TERRACE CIR, STE 501-503, FORT MYERS, FL 33907-8827
(239) 274-1000
(239) 274-1001
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
012
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770360
—
MS
01
—
3141695
BC/BS OF TN
TN
05
—
4287023
—
TN
Enumeration date
06/16/2005
Last updated
08/22/2020
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