1598879009 NPI number — DIGESTIVE DISEASES CENTER OF HATTIESBURG, LLC

Table of content: (NPI 1598879009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598879009 NPI number — DIGESTIVE DISEASES CENTER OF HATTIESBURG, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGESTIVE DISEASES CENTER OF HATTIESBURG, LLC
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:
1598879009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 METHODIST HOSPITAL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATTIESBURG
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39402-1295
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-268-5189
Provider Business Mailing Address Fax Number:
601-268-5006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 TURTLE CREEK DR STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HATTIESBURG
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39402-1173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-268-5189
Provider Business Practice Location Address Fax Number:
601-268-5006
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUCKLEY
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
601-268-5189

Provider Taxonomy Codes

  • Taxonomy code: 261QE0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02358833 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00138452 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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