NPIMap

Organization Active NPI

Oral & Maxillofacial Surgery Clinic of South Misssissippi, P.a.

Doing business as Hattiesburg Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Hattiesburg, MS
National Provider Identifier
1578596060
Registry record updated Jul 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
ORAL & MAXILLOFACIAL SURGERY CLINIC OF SOUTH MISSSISSIPPI, P.A.
Doing business as
Hattiesburg Oral Surgery
Practice address
1421 S 28TH Ave
Hattiesburg, MS 39402-3108
Phone
(601) 264-7611
Fax
(601) 268-0693
NPI assigned
Jul 8, 2006
Last updated
Jul 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2020

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

Authorized official

Name
Mrs. Sandra P Odom
Title
Administrator
Phone
(601) 261-9317

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NU Primary

Addresses

Primary practice location

1421 S 28TH Ave
Hattiesburg, MS 39402-3108

Mailing address

1421 S 28TH Ave
Hattiesburg, MS 39402-3108
Phone (601) 264-7611

Other identifiers 1

IdentifierTypeStateIssuer
06271376MedicaidMS

Other names 3

  • Hattiesburg Oral Surgery Doing business as
  • Drs. York, Bishop & West Other name
  • Drs. York, Cockerham & Hughes Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080508000373 MS Part B Supplier - Clinic/Group Practice 2163501602 Receives reassigned benefits from 4 practitioners
Practice locations: Hattiesburg, MS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595376000000",
    "number": "1578596060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023108",
            "telephone_number": "601-264-7611",
            "fax_number": "601-268-0693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023108",
            "telephone_number": "601-264-7611",
            "fax_number": "601-268-0693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL & MAXILLOFACIAL SURGERY CLINIC OF SOUTH MISSSISSIPPI, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A",
        "authorized_official_last_name": "ODOM",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-261-9317",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06271376",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hattiesburg Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hattiesburg Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Drs. York, Bishop & West",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Drs. York, Cockerham & Hughes",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; 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.