1821185786 NPI number — THE SURGICAL CLINIC ASSOCIATES, P.A.

Table of content: (NPI 1821185786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821185786 NPI number — THE SURGICAL CLINIC ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SURGICAL CLINIC ASSOCIATES, P.A.
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:
1821185786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 MARSHALL ST
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39202-1651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-948-1411
Provider Business Mailing Address Fax Number:
601-948-0090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 MARSHALL ST
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39202-1651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-948-1411
Provider Business Practice Location Address Fax Number:
601-948-0090
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HICKMAN
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
601-948-1411

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , 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: 09012031 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com