Organization
SOUTHERN SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID M. BURCKEL (CEO)
(601) 554-7525
Entity
Organization
Contact information
Practice address
3688 VETERANS MEMORIAL DR, SUITE 100, HATTIESBURG, MS 39401-8246
(601) 554-7525
(601) 554-7574
Mailing address
3688 VETERANS MEMORIAL DR, SUITE 100, HATTIESBURG, MS 39401-8246
(601) 554-7525
(601) 554-7574
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
015
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050871
BLUE CROSS & BLUE SHIELD
MS
05
—
00770390
—
MS
Enumeration date
07/19/2005
Last updated
12/28/2009
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