NPIMap

Organization Active NPI

Mississippi Ear, Nose and Throat Surgical Associates, PC

  • Specialist
  • Flowood, MS
National Provider Identifier
1679905210
Registry record updated May 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
12145 Issued in MS
Legal business name
MISSISSIPPI EAR, NOSE AND THROAT SURGICAL ASSOCIATES, PC
Practice address
2550 Flowood Dr
Suite 303
Flowood, MS 39232-9303
Phone
(601) 709-7707
Fax
(601) 709-7701
NPI assigned
Aug 6, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2014

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

Authorized official

Name
Dr. Clarence M Osborne, M.D.NPI 1548356983
Title
Medical Director
Phone
(601) 709-7707

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 12145 MS Primary

Addresses

Primary practice location

2550 Flowood Dr
Suite 303
Flowood, MS 39232-9303

Mailing address

2550 Flowood Dr
Suite 303
Flowood, MS 39232-9303
Phone (601) 709-7707

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040825000904 MS Part B Supplier - Clinic/Group Practice 5597739466 Receives reassigned benefits from 8 practitioners
3 other NPIs on this enrollment
Practice locations: Flowood, MS

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2097294Ms Ear, Nose, & Throat Surgical Associates2550 Flowood Drive, Suite 303, Flowood, MS 39232Certificate of waiverJun 10, 2027

National Provider Directory

National Provider Directory

Locations

2550 Flowood Dr
Ste 303
Flowood, MS 39232
Phone (601) 709-7700

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1375747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401235200000",
    "number": "1679905210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 FLOWOOD DR",
            "address_2": "SUITE 303",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329303",
            "telephone_number": "601-709-7707",
            "fax_number": "601-709-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 FLOWOOD DR",
            "address_2": "SUITE 303",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329303",
            "telephone_number": "601-709-7707",
            "fax_number": "601-709-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI EAR, NOSE AND THROAT SURGICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-06",
        "last_updated": "2014-05-28",
        "status": "A",
        "authorized_official_last_name": "OSBORNE",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "601-709-7707",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MS",
            "license": "12145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flowood, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.