Basic Information
| Provider Information | |||||||||
| NPI: | 1669427563 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | P & S SURGERY CENTER LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | P & S SURGICAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 53575 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705053575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3189986141 | ||||||||
| FaxNumber: | 3189986139 | ||||||||
| Practice Location | |||||||||
| Address1: | 312 GRAMMONT ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712017457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3189986141 | ||||||||
| FaxNumber: | 3189986139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 07/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | HICKS | ||||||||
| AuthorizedOfficialFirstName: | TERRI | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE-PRESIDENT, CFO | ||||||||
| AuthorizedOfficialTelephone: | 3189986141 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 490 | LA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1701998 | 05 | LA | MEDICAID |