Mae Physicians Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MAE PHYSICIANS SURGERY CENTER, LLC

Practice address

1190 N State St
Ste 102
Jackson, MS 39202-2413

Phone

(601) 968-1790

Fax

(601) 292-4531

NPI assigned

Nov 7, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Carla Glaze

Title

Administrator

Phone

(601) 968-1790

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Listed as

Mae Physicians Surgery Center LLCCCN 25C0001025

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Mississippi Sports Medicine & Orthopaedic Center

  • Orthopaedic Surgery Physician
  • Jackson, MS
  • NPI 1568415560

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Walter Rowen Shelton II, MD

  • Orthopaedic Surgery Physician
  • Jackson, MS
  • NPI 1578551792
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397088000000",
    "number": "1033190129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12673",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392362673",
            "telephone_number": "601-968-1790",
            "fax_number": "601-292-4531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 N STATE ST",
            "address_2": "STE 102",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022413",
            "telephone_number": "601-968-1790",
            "fax_number": "601-292-4531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAE PHYSICIANS SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-07",
        "last_updated": "2014-04-10",
        "status": "A",
        "authorized_official_last_name": "GLAZE",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-968-1790",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carley Danielle Maddox
• Renee A Maddox, RPT
• Eboni Madlock
• Brittney L Madonna, OTA
• Alexander Madrigal, PHARMACIST
• Brandi Magahey
• Charlotte Jean Magee, C.F.N.P.
• Lauren E Magee, RD,LD
• Sharon Gayle Magee, OTR/L
• Steve E Magee Jr., D.M.D.

• Ambulatory Surgical Clinic/Center in Jackson, MS
• Providers in Jackson, MS by specialty
• Ambulatory Surgical Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.