| Organization Name: | POPPS FERRY OUT-PATIENT SURGERY CENTER, LLC |
| NPI Number: | 1053649558 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREGORY E BERTUCCI (OWNER) |
| Mailing Address: | 431 Bertucci Blvd Biloxi |
| State: | MS US |
| Postal Code: | 395312255 |
| Phone Number: | 2283852020 |
| Fax Number: | 2283889435 |
| NPI Enumeration Date: | 11/23/2009 |
| NPI Last Update Date: | 11/18/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QS0132X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ophthalmologic Surgery |
| Taxonomy Definition: | |