Organization
SOG SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS LUSTER (CEO)
(662) 767-4200
Entity
Organization
Contact information
Practice address
1211 S GLOSTER ST STE B, TUPELO, MS 38801-6535
(662) 432-1490
Mailing address
1211 S GLOSTER ST STE B, TUPELO, MS 38801-6548
(662) 432-1490
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
09/13/2018
Last updated
06/04/2020
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