NPIMap

Organization Active NPI

Coastal Ear, Nose and Throat, Head and Neck Surgery Associates, PLLC

  • Specialist
  • Gulfport, MS
National Provider Identifier
1366560435
Registry record updated Apr 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
COASTAL EAR, NOSE AND THROAT, HEAD AND NECK SURGERY ASSOCIATES, PLLC
Practice address
407 Security SQ
Gulfport, MS 39507-1922
Phone
(228) 896-1987
Fax
(228) 896-1315
NPI assigned
Mar 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2015

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

Authorized official

Name
Jason Smith, M.D.
Title
Owner
Phone
(228) 863-6617

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

407 Security SQ
Gulfport, MS 39507-1922

Mailing address

407 Security SQ
Gulfport, MS 39507-1922
Phone (228) 896-1987

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040728000361 MS Part B Supplier - Clinic/Group Practice 0042280067 Receives reassigned benefits from 17 practitioners
Practice locations: Biloxi, MS; Gulfport, MS

National Provider Directory

National Provider Directory

Locations

2012 Highway 90
Gautier, MS 39553
Phone (228) 696-0336

3017 13th St
Gulfport, MS 39501
Phone (228) 831-0050

407 Security Sq
Gulfport, MS 39507
Phone (228) 896-1987

1213 Broad Ave
Ste 4
Gulfport, MS 39501
Phone (228) 863-4490

4300 15th St
#B
Gulfport, MS 39501
Phone (228) 864-0828

3704 Bienville Blvd
#A
Ocean Springs, MS 39564

3705 Bienville Blvd Ste A1
Ocean Springs, MS 39564

3074 Bienville Blvd Ste A1
Ocean Springs, MS 39564

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429747200000",
    "number": "1366560435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 SECURITY SQ",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395071922",
            "telephone_number": "228-896-1987",
            "fax_number": "228-896-1315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 SECURITY SQ",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395071922",
            "telephone_number": "228-896-1987",
            "fax_number": "228-896-1315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL EAR, NOSE AND THROAT, HEAD AND NECK SURGERY ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2015-04-23",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-863-6617",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.