Hattiesburg Clinic, PA
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Wiggins, MS
NPI 1508899824 · NPPES record last updated Feb 18, 2021
Key facts
- NPI
- 1508899824
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- HATTIESBURG CLINIC, PA
- Practice address
- 503 First St S
Wiggins, MS 39577-2763 - Phone
- (601) 928-2998
- Fax
- (601) 928-2967
- NPI assigned
- Jul 9, 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 Care Compare: Dialysis facility
- Listed as
- Wiggins Dialysis
- Overall star rating
- ★★★★☆ 4.0 of 5
- Ownership
- Profit
- Certified
- Jun 8, 1994
- Medicare certification status
- Active
- Dialysis stations
- 12
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D0889303 | Wiggins Dialysis Unit | Certificate of waiver | Jul 24, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111227000760 | MS | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 5193706794 | Practice locations: Wiggins, MS |
National Provider Directory
- Tax ID family
- Hattiesburg Clinic PA
Locations
503 First St S
Wiggins, MS 39577
Phone (601) 928-2998
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Yes |
Addresses
Primary practice location
503 First St S
Wiggins, MS 39577-2763
Mailing address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 928-2998
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5000477 | Other | MS | UNITED HEALTHCARE |
| 00220236 | Medicaid | MS | |
| 000050533 | Other | MS | BLUE CROSS BLUE SHIELD MS |
Other names
- Wiggins Dialysis Unit
Other providers in Wiggins, MS
- Devon D Hand
- Hands of Hope
- Ryan H. Harrell
- Rebecca Harris
- Hattiesburg Clinic PA
- Hailee Herman
- Rebekah Heyer
- Hometown Family Pharmacy, Inc.
- Sarah Huba
- Melanie Linton Hughes
All providers in Wiggins, MS · End-Stage Renal Disease (ESRD) Treatment Clinic/Center 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.