Provider Demographics
NPI:1851113567
Name:ROYAL SURGERY CENTER
Entity type:Organization
Organization Name:ROYAL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROYAL
Authorized Official - Middle Name:SURGERY
Authorized Official - Last Name:CENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-804-7480
Mailing Address - Street 1:107 FRONT ST STE 2126
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-2835
Mailing Address - Country:US
Mailing Address - Phone:318-336-2216
Mailing Address - Fax:
Practice Address - Street 1:107 FRONT ST STE 2126
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-2835
Practice Address - Country:US
Practice Address - Phone:318-336-2216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health