Provider Demographics
NPI:1932977360
Name:SCB SURGERY CENTER LLC
Entity type:Organization
Organization Name:SCB SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CALHOUN
Authorized Official - Last Name:MOAK
Authorized Official - Suffix:III
Authorized Official - Credentials:RN
Authorized Official - Phone:318-278-1955
Mailing Address - Street 1:2480 HIGHWAY 33
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5093
Mailing Address - Country:US
Mailing Address - Phone:318-224-2404
Mailing Address - Fax:318-224-4402
Practice Address - Street 1:2480 HWY 33
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2468
Practice Address - Country:US
Practice Address - Phone:318-224-2404
Practice Address - Fax:318-224-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty