1386670511 NPI number — HATTIESBURG AMBULATORY SURGERY CENTER LP

Table of content: (NPI 1386670511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386670511 NPI number — HATTIESBURG AMBULATORY SURGERY CENTER LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HATTIESBURG AMBULATORY SURGERY CENTER LP
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:
6
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:
1386670511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 849823
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-9823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-296-3800
Provider Business Mailing Address Fax Number:
601-296-3810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 FRANKLIN RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HATTIESBURG
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39402-1366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-296-3800
Provider Business Practice Location Address Fax Number:
601-296-3810
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLTSFORD
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, BUSINESS OFFICE SUPPORT
Authorized Official Telephone Number:
615-465-7466

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  024 , 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: 04275391 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00172366 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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