Mississippi Comprehensive Treatment Centers, LLC

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

Legal business name

MISSISSIPPI COMPREHENSIVE TREATMENT CENTERS, LLC

Doing business as

Gulf Coast Comprehensive Treatment Center

Practice address

14070 Dedeaux Rd
Gulfport, MS 39503-4502

Phone

(877) 533-5686

NPI assigned

Jan 16, 2017

Organization subpart

No

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

Authorized official

Name

John Peloquin, PHD

Title

President, CTC Division

Phone

(855) 259-2288

Specialties & licenses 1

Addresses

Other names 1

• Gulf Coast Comprehensive Treatment Center Doing business as

Tax ID family

Gulf Coast Comprehensive Treatment Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Mississippi Comprehensive Treatment Centers, LLC

  dba Jackson Comprehensive Treatment Center

  • Methadone Clinic
  • Jackson, MS
  • NPI 1629510540
  NPD tax ID

Locations

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

{
    "created_epoch": "1484524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484524800000",
    "number": "1467998344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6185 PASEO DEL NORTE STE 150",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920111155",
            "telephone_number": "855-259-2288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14070 DEDEAUX RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034502",
            "telephone_number": "877-533-5686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI COMPREHENSIVE TREATMENT CENTERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-16",
        "last_updated": "2017-01-16",
        "status": "A",
        "authorized_official_last_name": "PELOQUIN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT, CTC DIVISION",
        "authorized_official_telephone_number": "855-259-2288",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gulf Coast Comprehensive Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Miracle Birth OB-GYN, PA
• Vibha Mishra-Nicaud, DO
• Abha Mishra, MD
• Mission Home Care Services
• Mississippi Ambulance Service
• Mississippi CVS Pharmacy, L.L.C. (CVS Pharmacy #05908)
• Mississippi CVS Pharmacy, L.L.C. (CVS Pharmacy # 05923)
• Mississippi Orthopaedic Institute
• Mississippi State Department of Health
• Ami C Mitchell, OT

• Methadone Clinic in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Methadone Clinic in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.