1124584800 NPI number — TEESSA PEREKATTU KURUVILLA MD

Table of content: TEESSA PEREKATTU KURUVILLA MD (NPI 1124584800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124584800 NPI number — TEESSA PEREKATTU KURUVILLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREKATTU KURUVILLA
Provider First Name:
TEESSA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1124584800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNIVERSITY OF MS MEDICAL CENTER
Provider Second Line Business Mailing Address:
2500 N STATE ST DEPARTMENT OF RADIATION ONCOLOGY
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39216-4505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-815-6886
Provider Business Mailing Address Fax Number:
601-815-1846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DEPARTMENT OF RADIATION ONCOLOGY
Provider Second Line Business Practice Location Address:
350 WOODROW WILSON DR
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216-4505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-815-6886
Provider Business Practice Location Address Fax Number:
601-815-1846
Provider Enumeration Date:
02/18/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  01095903A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: T-3726 , 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: T-3726 . This is a "MS STATE BOARD OF MEDICAL LICENSURE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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