Suzanne Massey

  
 Gulf Coast 
 SURGICAL CENTER, LLC 
 402 Dunn Street 
 Houma, LA 76560 (985) 865-1651 Fax (965) 865-6658 
 Tax ID: 20-3335700
 NPI #: 122895236 
 B/C#: 1283779618614Z 
 Insurance Verification Form 
 Pt. Name: Suzanne Massey 
 DATE OF BIRTH: 1988 February 18 
 MR# 48465-3 
 BCBS OF LA HMO 
 Insurance Company: 
 Phone Number: 1-252-476-6432
 Insured Name: SELF 
 Relationship to Patient: 
 Policy Number: IHQ828377961861 
 Group Number: 
 Effective Date: 2023 April 20
 Policy paid thru: ACTIVE 
 DATE OF PROCEDURE: 2015 May 02
 Pre-cert company name: 
 Claims Address: BCBS OF LA 
 Does policy follow MNRP/MRC2? yes or no 
 PO BOX 96529 
 Do benefits co-incide? 
 yes or no 
 BATON ROUGE, LA 70658 
 Rep. Name: ONLINE 1 Austin 
