EYE CARE SURGERY CENTER OF SOUTHAVENLLC NPI 1780767673

NPI Information

EYE CARE SURGERY CENTER OF SOUTHAVEN,LLC is an ambulatory surgical clinic center in Southaven, MS. EYE CARE SURGERY CENTER OF SOUTHAVEN,LLC NPI is 1780767673. The provider is registered as an organization entity type.

The provider's business location address is:

7600 AIRWAYS BLVD
SUITE D
SOUTHAVEN, MS
ZIP 38671-138
Phone: (662) 349-7477
Fax: (662) 349-7478

The provider's authorized official is Subba R. Gollamudi .
The authorized official title is Medical Director and has the following contact phone number (901) 685-2200.

The CLIA number assigned to this NPI record is 25D1031434 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/23/2006 and was last updated on 3/15/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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