Organization
EYE AND AESTHETIC SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DELL C CHOATE (ADMINISTRATOR)
(601) 684-3112
Entity
Organization
Contact information
Practice address
414B MARION AVE, MCCOMB, MS 39648-2710
(601) 684-9675
(601) 684-9919
Mailing address
414B MARION AVE, MCCOMB, MS 39648-2710
(601) 684-9675
(601) 684-9919
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
25C0001019
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770292
—
MS
Enumeration date
01/13/2007
Last updated
05/20/2008
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