1871770305 NPI number — DIS SOLUTIONS LLC

Table of content: (NPI 1871770305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871770305 NPI number — DIS SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIS SOLUTIONS 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:
6
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:
1871770305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2371
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STARKVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39760-2371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
403 HOSPITAL RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
STARKVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39759-2164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-320-9696
Provider Business Practice Location Address Fax Number:
662-323-5719
Provider Enumeration Date:
01/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HUDDLESTON
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
RUSS
Authorized Official Title or Position:
CHIEF OPER OFFICE
Authorized Official Telephone Number:
662-769-0280

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  04633/02.1 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 04633/021 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 04633021 , 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: 2587143 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00330522 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000030527 . This is a "BC BS OF MS HIT" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00440638 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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