Hattiesburg Clinic PA
Organization Active NPI Podiatrist · Hattiesburg, MS
NPI 1326135641 · NPPES record last updated Feb 18, 2021
Key facts
- NPI
- 1326135641
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- Legal business name
- HATTIESBURG CLINIC PA
- Practice address
- 1101B S 28TH Ave
Hattiesburg, MS 39402-2610 - Phone
- (601) 579-5117
- Fax
- (601) 261-0889
- NPI assigned
- Oct 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Bryan N Batson, MD
- Title
- Executive Director
- Phone
- (601) 264-6000
Corporate family (same tax ID) 24
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930059115 | MS | DME Supplier - Physician - General Practice | 5193706794 | Practice locations: Hattiesburg, MS |
National Provider Directory
- Tax ID family
- Hattiesburg Clinic PA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | Yes |
Addresses
Primary practice location
1101B S 28TH Ave
Hattiesburg, MS 39402-2610
Mailing address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 579-5463
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06553325 | Medicaid | MS |
Other names
- Podiatry
Other providers in Hattiesburg, MS
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
All providers in Hattiesburg, MS · Podiatrist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.