1336895762 NPI number — ELIZABETH ANN POND EXECUTIVE DIRECTOR

Table of content: ELIZABETH ANN POND EXECUTIVE DIRECTOR (NPI 1336895762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336895762 NPI number — ELIZABETH ANN POND EXECUTIVE DIRECTOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POND
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
EXECUTIVE DIRECTOR
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:
1336895762
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
670 BAY COVE DR
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:
39532-5546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-702-9972
Provider Business Mailing Address Fax Number:
228-702-9978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
670 BAY COVE DR
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:
39532-5546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-702-9972
Provider Business Practice Location Address Fax Number:
228-702-9978
Provider Enumeration Date:
02/24/2022

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: 376G00000X , with the licence number:  1066 , 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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