1275719114 NPI number — JERRY L. STENNET, M.D. PA D/B/A COLUMBUS SURGERY

Table of content: (NPI 1275719114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275719114 NPI number — JERRY L. STENNET, M.D. PA D/B/A COLUMBUS SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JERRY L. STENNET, M.D. PA D/B/A COLUMBUS SURGERY
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:
1275719114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1019
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39703-1019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-328-1862
Provider Business Mailing Address Fax Number:
662-328-7597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 BAPTIST BLVD
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39705-2011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-328-1862
Provider Business Practice Location Address Fax Number:
662-328-7597
Provider Enumeration Date:
01/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STENNETT
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
662-328-1862

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  07718 , 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)





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