Surgical Suites at the Wall Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

SURGICAL SUITES AT THE WALL CENTER, LLC

Practice address

8600 Fern Avenue
Ste. 200
Shreveport, LA 71105

Phone

(318) 795-0801

Fax

(318) 795-9492

NPI assigned

Sep 10, 2008

Organization subpart

No

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

Authorized official

Name

Simeon H. Wall Jr., M.D.NPI 1275522682

Title

Medical Director

Phone

(318) 795-0801

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386893758. Details of each certification follow.

• CCN 19C0001118 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 19C0001118

Legal name

SURGICAL SUITES AT THE WALL CENTER

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Oct 13, 2009

Last certification

Aug 10, 2018

Ownership / control type

Proprietary

Facility address

8600 Fern Avenue
Shreveport, LA 71105

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

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Simeon Wall Jr., MD, FACS

  • Plastic and Reconstructive Surgery Physician
  • Shreveport, LA
  • NPI 1275522682
  NPD (past) Authorized official

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

{
    "created_epoch": "1221004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240272000000",
    "number": "1386893758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 FERN AVENUE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71105",
            "telephone_number": "318-795-0801",
            "fax_number": "318-795-9492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 FERN AVENUE",
            "address_2": "STE. 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71105",
            "telephone_number": "318-795-0801",
            "fax_number": "318-795-9492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL SUITES AT THE WALL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-10",
        "last_updated": "2009-04-21",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "SIMEON",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "318-795-0801",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phani Surapaneni, M.D.
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• Surgical Specialists of Shreveport, LLC
• Surgical Specialty Center, LLC
• Raja Suri, MD
• Fnu Surkasha, MD
• Susan E. Kemp, MD, LLC
• Susan M Seiler-Smith & Willis-Knighton Medical Center
• Michael Vittorio Susano, M.D.

• Ambulatory Surgical Clinic/Center in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Ambulatory Surgical Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.