Provider Demographics
NPI:1134157225
Name:OCEAN SPRINGS SURGICAL AND ENDOSCOPY CENTER LLC
Entity type:Organization
Organization Name:OCEAN SPRINGS SURGICAL AND ENDOSCOPY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:3301 BIENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-4318
Mailing Address - Country:US
Mailing Address - Phone:228-872-8854
Mailing Address - Fax:228-872-0265
Practice Address - Street 1:3301 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4318
Practice Address - Country:US
Practice Address - Phone:228-872-8854
Practice Address - Fax:228-872-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS020261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770575Medicaid
MS610522000OtherDEPT OF LABOR WC
MS000050045OtherBCBS
MS490005447OtherRAILROAD MEDICARE
MS490000031Medicare ID - Type Unspecified