NPIMap

Organization Active NPI

New Cedar Lake Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Biloxi, MS
National Provider Identifier
1295820249
Registry record updated Feb 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
004 Issued in MS
Legal business name
NEW CEDAR LAKE SURGERY CENTER, LLC
Practice address
1720 Medical Park Dr # B
Biloxi, MS 39532-2131
Phone
(228) 702-2000
Fax
(228) 702-2019
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2017

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

Authorized official

Name
Mr. Charles J Wilson, M.D.NPI 1558311431
Title
Owner and Director
Phone
(228) 702-2000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 004 MS Primary

Addresses

Primary practice location

1720 Medical Park Dr # B
Biloxi, MS 39532-2131

Mailing address

1720 Medical Park Dr # B
Biloxi, MS 39532-2131
Phone (228) 702-2000

Other identifiers 1

IdentifierTypeStateIssuer
00770025MedicaidMS

Other names 1

  • The Surgery Center at Cedar Lake Doing business as

National Provider Directory

National Provider Directory

Locations

1720 Medical Park Dr
#B
Biloxi, MS 39532
Phone (228) 702-2000

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1295820249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 MEDICAL PARK DR # B",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395322131",
            "telephone_number": "228-702-2000",
            "fax_number": "228-314-2589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 MEDICAL PARK DR # B",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395322131",
            "telephone_number": "228-702-2000",
            "fax_number": "228-702-2019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW CEDAR LAKE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER AND DIRECTOR",
        "authorized_official_telephone_number": "228-702-2000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MS",
            "license": "004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00770025",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Surgery Center at Cedar Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Biloxi, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.