1770537920 NPI number — BILOXI HMA PHYSICIAN MANAGEMENT LLC

Table of content: (NPI 1770537920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770537920 NPI number — BILOXI HMA PHYSICIAN MANAGEMENT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BILOXI HMA PHYSICIAN MANAGEMENT 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:
1770537920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 689022
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37068-9022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-465-7000
Provider Business Mailing Address Fax Number:
615-628-6877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
147 REYNOIR ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39530-4109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-436-1583
Provider Business Practice Location Address Fax Number:
228-436-1591
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SENIOR DIRECTOR PROVIDER ENROLLMENT
Authorized Official Telephone Number:
615-465-7000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 06383020 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01207807 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08151281 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04433025 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05187063 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07570526 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02388061 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08872257 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04933778 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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