1619346863 NPI number — SOUTH CENTRAL CLINICS, INC.

Table of content: DR. GABRIELLE MORI PT, DPT (NPI 1326784794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619346863 NPI number — SOUTH CENTRAL CLINICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH CENTRAL CLINICS, INC.
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:
SOUTH CENTRAL DIAGNOSTIC 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:
1619346863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 247
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39441-0247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-425-7550
Provider Business Mailing Address Fax Number:
601-399-6281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1440 JEFFERSON ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39440-4243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-649-6213
Provider Business Practice Location Address Fax Number:
601-649-6217
Provider Enumeration Date:
09/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CANIZARO
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CFO/VP OF FINANCE
Authorized Official Telephone Number:
601-399-6139

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01880574 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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