1619200318 NPI number — BILOXI URGENT CARE CENTER LLC

Table of content: (NPI 1619200318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619200318 NPI number — BILOXI URGENT CARE CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BILOXI URGENT CARE CENTER LLC
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:
1619200318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 LAMEUSE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILOXI
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39530-3107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-374-7888
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 LAMEUSE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39530-3107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-374-7888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BARNES
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
228-374-7888

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  09295 , 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: 00019091 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558396010 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com