1750630232 NPI number — HEALTH PARTNERS, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750630232 NPI number — HEALTH PARTNERS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH PARTNERS, PA
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:
1750630232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17708
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:
39404-7708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-296-2552
Provider Business Mailing Address Fax Number:
601-296-2554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 LINCOLN PKWY
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
HATTIESBURG
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39402-3262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-296-7848
Provider Business Practice Location Address Fax Number:
601-296-2397
Provider Enumeration Date:
08/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MONDAY
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING ADMIN
Authorized Official Telephone Number:
601-296-2552

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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