NPIMap

Organization Active NPI

Hattiesburg Clinic PA

Doing business as Clinical Laboratory

  • Clinical Medical Laboratory
  • Hattiesburg, MS
National Provider Identifier
1053493460
Registry record updated Oct 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
HATTIESBURG CLINIC PA
Doing business as
Clinical Laboratory
Practice address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone
(601) 268-5735
Fax
(601) 268-5852
NPI assigned
Oct 19, 2006
Last updated
Oct 7, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bryan N Batson, MD
Title
Executive Director
Phone
(601) 268-5601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

415 S 28TH Ave
Hattiesburg, MS 39401-7246

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 579-5488

Other identifiers 1

IdentifierTypeStateIssuer
00014811MedicaidMS

Other names 1

  • Clinical Laboratory Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041021000326 MS Part B Supplier - Independent Clinical Laboratory 5193706794 Practice locations: Hattiesburg, MS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0318924Hattiesburg Clinic Urology415 S 28TH Ave, Hattiesburg, MS 39401ComplianceMar 29, 2028
25D0662436Hattiesburg Clinic Pulmonary Lab415 South 28TH Avenue, Hattiesburg, MS 39401ComplianceDec 8, 2027
25D2029926Poc Hattiesburg Clinic Main Campus415 S 28TH Avenue, Hattiesburg, MS 39401Certificate of waiverSep 15, 2027
25D2116928Vascular Specialists Obl Lab415 S 28TH Avenue, Hattiesburg, MS 39401Certificate of waiverMay 25, 2028

National Provider Directory

National Provider Directory
Tax ID family
Hattiesburg Clinic PA136 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602028800000",
    "number": "1053493460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-579-5488",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-268-5735",
            "fax_number": "601-268-5852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HATTIESBURG CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A",
        "authorized_official_last_name": "BATSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-268-5601",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00014811",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinical Laboratory",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinical Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.