1003397530 NPI number — THE NATIONAL DIABETES & OBESITY RESEARCH INSTITUTE AT TRADITION, MISSI

Table of content: (NPI 1003397530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003397530 NPI number — THE NATIONAL DIABETES & OBESITY RESEARCH INSTITUTE AT TRADITION, MISSI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE NATIONAL DIABETES & OBESITY RESEARCH INSTITUTE AT TRADITION, MISSI
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:
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Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003397530
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19289 ST. JOSEPH STREET
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
BILOXI
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-831-8764
Provider Business Mailing Address Fax Number:
228-233-1252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19289 ST. JOSEPH STREET
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-831-8764
Provider Business Practice Location Address Fax Number:
228-233-1252
Provider Enumeration Date:
08/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
FOS
Authorized Official First Name:
PETER
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
228-831-8764

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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