Basic Information
| Provider Information | |||||||||
| NPI: | 1841581352 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH CENTRAL CINICS, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE COSMETIC & PLASTIC SURGERY CENTER OF SOUTH CENTRAL MISSISSIPPI | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 247 | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394410247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014257522 | ||||||||
| FaxNumber: | 6014257524 | ||||||||
| Practice Location | |||||||||
| Address1: | 1410 JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394404243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014257522 | ||||||||
| FaxNumber: | 6014257524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2011 | ||||||||
| LastUpdateDate: | 05/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | MORROW | ||||||||
| AuthorizedOfficialFirstName: | MONICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR CLINIC SUPPORT | ||||||||
| AuthorizedOfficialTelephone: | 6014257550 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SOUTH CENTRAL REGIONAL MEDICAL CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
No ID Information.