1457350449 NPI number — BAPTIST AND PHYSICIANS OUTPATIENT SURGERY CENTER OF NORTH MS, LP

Table of content: (NPI 1457350449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457350449 NPI number — BAPTIST AND PHYSICIANS OUTPATIENT SURGERY CENTER OF NORTH MS, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST AND PHYSICIANS OUTPATIENT SURGERY CENTER OF NORTH MS, LP
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:
OXFORD SURGERY CENTER
Provider Other Organization Name Type Code:
3
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:
1457350449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
499 AZALEA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38655-7901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-234-7979
Provider Business Mailing Address Fax Number:
662-234-7079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
499 AZALEA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38655-7901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-234-7979
Provider Business Practice Location Address Fax Number:
662-234-7079
Provider Enumeration Date:
07/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SHORTER
Authorized Official First Name:
JAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
662-234-7979

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  018 , 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)

  • Identifier: 00770526 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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