1821204736 NPI number — MISSISSIPPI EAR, NOSE AND THROAT SURGICAL ASSOCIATES, P.C.

Table of content: (NPI 1821204736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821204736 NPI number — MISSISSIPPI EAR, NOSE AND THROAT SURGICAL ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSISSIPPI EAR, NOSE AND THROAT SURGICAL ASSOCIATES, P.C.
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:
1821204736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2550 FLOWOOD DR STE 303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOWOOD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39232-9306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-709-7700
Provider Business Mailing Address Fax Number:
601-709-7701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 RIVER OAKS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-709-7700
Provider Business Practice Location Address Fax Number:
601-709-7701
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HINES
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
PEYTON
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
662-571-7129

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1023455169 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02652740 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com