Provider Demographics
NPI:1679554190
Name:CORINTH SURGERY CENTER, LLC
Entity type:Organization
Organization Name:CORINTH SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:662-293-2000
Mailing Address - Street 1:401 ALCORN DR STE 1C
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9071
Mailing Address - Country:US
Mailing Address - Phone:662-293-2000
Mailing Address - Fax:662-665-0857
Practice Address - Street 1:401 ALCORN DR STE 1C
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9071
Practice Address - Country:US
Practice Address - Phone:662-293-2000
Practice Address - Fax:662-665-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSDC8520OtherRR MEDICARE GROUP NUMBER
MS03707532Medicaid
MS=========AOtherBCBSMS GROUP NUMBER
MS03707532Medicaid