Provider Demographics
NPI:1972607489
Name:GARDNER SURGERY CENTER INC
Entity type:Organization
Organization Name:GARDNER SURGERY CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:318-322-5506
Mailing Address - Street 1:3101 KILPATRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5157
Mailing Address - Country:US
Mailing Address - Phone:318-322-5506
Mailing Address - Fax:318-322-5916
Practice Address - Street 1:3101 KILPATRICK BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5157
Practice Address - Country:US
Practice Address - Phone:318-322-5506
Practice Address - Fax:318-322-5916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA83261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11040Medicare ID - Type Unspecified