Patriot Healthcare of Mississippi, LLC

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

PATRIOT HEALTHCARE OF MISSISSIPPI, LLC

Practice address

1110 Broad Street
Suite 300
Gulfport, MS 39501

Phone

(228) 563-4787

NPI assigned

Nov 15, 2018

Organization subpart

No

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

Authorized official

Name

David A. Culver

Title

Administrator

Phone

(904) 825-4368

Specialties & licenses 1

Addresses

Other names 1

• PHC of MS Gulfport Doing business as

Locations

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

{
    "created_epoch": "1542240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542240000000",
    "number": "1477022838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 ARRICOLA AVENUE",
            "city": "ST. AUGUSTINE",
            "state": "FL",
            "postal_code": "32080",
            "telephone_number": "904-825-4368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 BROAD STREET",
            "address_2": "SUITE 300",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "39501",
            "telephone_number": "228-563-4787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRIOT HEALTHCARE OF MISSISSIPPI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-15",
        "last_updated": "2018-11-15",
        "status": "A",
        "authorized_official_last_name": "CULVER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-825-4368"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHC of MS Gulfport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kayla Marie Pate, RPH
• Indrajit J Patel, MD
• Simal Patel, MD
• Path of Passion Homecare LLC
• Patient Care Pharmacy Inc
• Patten Family Chiropractic PC
• Teresa Demetrius Patton, DPT
• Victoria Patton, CSS
• Anna Pavlov, MD
• Carrie Joyce Payne-Morris, MSCCC-SLP,MPH

• Geriatric Medicine (Family Medicine) Physician in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Geriatric Medicine (Family Medicine) Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2018; 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.