1285911693 NPI number — SOUTHERN MS HEART CENTER,PA

Table of content: DR. ROBERT LEWIS MOBLEY JR. M.D. (NPI 1790008803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285911693 NPI number — SOUTHERN MS HEART CENTER,PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN MS HEART CENTER,PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285911693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 HOSPITAL ST STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASCAGOULA
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39581-5329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-762-1002
Provider Business Mailing Address Fax Number:
228-762-1012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7001 HIGHWAY 614
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURLEY
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-762-1002
Provider Business Practice Location Address Fax Number:
228-762-1012
Provider Enumeration Date:
11/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
COUCH
Authorized Official First Name:
AMY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
228-762-1002

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CG1009 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 09014546 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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