Laurel Surgery & Endoscopy Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

025 Issued in MS

Legal business name

LAUREL SURGERY & ENDOSCOPY CENTER, LLC

Practice address

1710 W 12TH St
Laurel, MS 39440-2559

Phone

(601) 369-2021

NPI assigned

Jul 5, 2006

Last updated

Apr 18, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lisa Bergin

Title

Administrator

Phone

(601) 369-2021

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Listed as

Laurel Surgery and Endoscopy Center LLCCCN 25C0001048

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

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

• South Central Regional Medical Center

  dba South Central Regional Medical Center-Cardiology

  • Internal Medicine Physician
  • Laurel, MS
  • NPI 1700934676

  Member Of

  NPD member

Member organizations 5

Organizations listed as members of this organization in the National Provider Directory.

• South Central Clinics, Inc

  dba South Central Orthopaedics

  • Orthopaedic Surgery Physician
  • Laurel, MS
  • NPI 1265615249

  Member Of

  NPD member
• South Central Clinics, Inc

  dba South Central Family Medicine

  • Rural Health Clinic/Center
  • Laurel, MS
  • NPI 1669609111

  Member Of

  NPD member
• South Central Clinics, Inc

  dba Sandersville Medical Clinic

  • Family Medicine Physician
  • Sandersville, MS
  • NPI 1972888659

  Member Of

  NPD member
• South Central Regional Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Laurel, MS
  • NPI 1588660336

  Member Of

  NPD member
• South Central Regional Medical Center

  dba South Central Specialty Pharmacy

  • Community/Retail Pharmacy
  • Laurel, MS
  • NPI 1841913068

  Member Of

  NPD member

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Laurel Surgery & Endoscopy Center, LLC

  dba Laurel Surgery & Endo Anesthesia

  • Anesthesiology Physician
  • Laurel, MS
  • NPI 1639249394
  NPPES parent name

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.

• D Enise W Reynolds, M.D.

  • Anesthesiology Physician
  • Hattiesburg, MS
  • NPI 1033144118
  NPD

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681776000000",
    "number": "1689605826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 W 12TH ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394402559",
            "telephone_number": "601-369-2021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 W 12TH ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394402559",
            "telephone_number": "601-369-2021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAUREL SURGERY & ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "BERGIN",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-369-2021"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MS",
            "license": "025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01357572",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000050710",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laurel Pain Clinic PA
• Laurel Pharmacy, LLC
• Laurel Plastic Surgery LLC
• Laurel Speech, Language and Hearing Ctr
• Laurel Surgery & Endoscopy Center, LLC (Laurel Surgery & Endo Anesthesia)
• Laurel Urology Clinic PA
• Caitlin Lei Foong Lean
• Jeffrey Stuart Leblanc, D.D.S.
• Legendary Orthodontics, LLC
• Kent B Leggett, D.M.D.

• Ambulatory Surgical Clinic/Center in Laurel, MS
• Providers in Laurel, 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 18, 2023; 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.