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Hattiesburg Clinic PA

Organization Active NPI Multi-Specialty Clinic/Center · Hattiesburg, MS

NPI 1740213446 · NPPES record last updated Oct 7, 2020

Key facts

NPI
1740213446
Entity type
Organization (NPI type 2)
Primary specialty
Multi-Specialty Clinic/Center 261QM1300X
Legal business name
HATTIESBURG CLINIC PA
Practice address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone
(601) 579-5488
Fax
(601) 579-5240
NPI assigned
Jul 8, 2006
Organization subpart
No

Authorized official

Name
Dr. Bryan N Batson
Title
Executive Director
Phone
(601) 268-5601

Other NPIs on the same Medicare enrollment 31

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

View all 31

Corporate family (same tax ID) 24

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 706

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

View all 706

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MS

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040528000685 MS Part B Supplier - Clinic/Group Practice 5193706794 Receives reassigned benefits from 699 practitioners
31 other NPIs on this enrollment
O20100930076717 MS DME Supplier - Multi-Specialty - Physician 5193706794 Practice locations: Hattiesburg, MS

National Provider Directory

Tax ID family
Hattiesburg Clinic PA (136 organizations share this tax ID)

Locations

415 S 28th Ave
#1J
Hattiesburg, MS 39401

415 S 28th Ave
Fl Second
Hattiesburg, MS 39401

415 S 28th Ave
Fl 2
Hattiesburg, MS 39401
Phone (601) 579-5010

415 S 28th Ave
#2C
Hattiesburg, MS 39401

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Yes

Addresses

Primary practice location

415 S 28TH Ave
Hattiesburg, MS 39401-7246

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 579-5463

Other identifiers

IdentifierTypeStateIssuer
09014185MedicaidMS

Other providers in Hattiesburg, MS

All providers in Hattiesburg, MS · Multi-Specialty Clinic/Center in Mississippi

Sources for this page

Verify at the official NPI Registry.