NPIMap

Hattiesburg Clinic PA

Organization Active NPI Family Medicine Physician · Columbia, MS

NPI 1295835544 · NPPES record last updated Feb 18, 2021

Key facts

NPI
1295835544
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
HATTIESBURG CLINIC PA
Practice address
502 Broad St
Columbia, MS 39429-3037
Phone
(601) 736-8282
Fax
(601) 736-8333
NPI assigned
Sep 25, 2006
Organization subpart
No

Authorized official

Name
Bryan N Batson
Title
Executive Director
Phone
(601) 264-6000

Other NPIs on the same Medicare enrollment 31

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 31

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0662431Columbia Family Clinic
502 Broad Street, Columbia, MS 39429		ComplianceOct 6, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MS

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040528000685 MS Part B Supplier - Clinic/Group Practice 5193706794 Receives reassigned benefits from 699 practitioners
31 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Hattiesburg Clinic PA (136 organizations share this tax ID)

Locations

502 Broad St
Columbia, MS 39429
Phone (601) 736-8282

430 S Spring St
Burlington, NC 27215

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

502 Broad St
Columbia, MS 39429-3037

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 579-5463

Other identifiers

IdentifierTypeStateIssuer
09013842MedicaidMS

Other names

  • Columbia Family Clinic Doing business as

Other providers in Columbia, MS

All providers in Columbia, MS · Family Medicine Physician in Mississippi

Sources for this page

Verify at the official NPI Registry.