1285782839 NPI number — MRS. SUSAN W BATES RPT

Table of content: MRS. SUSAN W BATES RPT (NPI 1285782839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285782839 NPI number — MRS. SUSAN W BATES RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BATES
Provider First Name:
SUSAN
Provider Middle Name:
W
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BATES
Provider Other First Name:
ANITA
Provider Other Middle Name:
SUSAN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285782839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12751 HIGHWAY 491 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNION
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39365-8546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-656-6827
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 AVIGNON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGELAND
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39157-5120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-605-6777
Provider Business Practice Location Address Fax Number:
601-605-8869
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT0886 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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