| Organization Name: | CENTER FOR SOUTHSIDE SURGERY, LLC |
| NPI Number: | 1003292483 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTINA MANDABACH (DIRECTOR OF BUSINESS OPS) |
| Mailing Address: | 533 E County Line Rd Suite 201 Greenwood |
| State: | IN US |
| Postal Code: | 461431073 |
| Phone Number: | 3177067246 |
| Fax Number: | 3177063419 |
| NPI Enumeration Date: | 08/07/2015 |
| NPI Last Update Date: | 08/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |