Basic Information
| Provider Information | |||||||||
| NPI: | 1528259686 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MADISON SURGICARE CENTER, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 971 LAKELAND DR | ||||||||
| Address2: | SUITE 1250 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013661011 | ||||||||
| FaxNumber: | 6013667311 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 HIGHLAND WAY | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391106915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013661011 | ||||||||
| FaxNumber: | 6013667311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 08/05/2007 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6013661011 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.