NPIMap

Organization Active NPI

Mississippi Breast Center PLLC

  • Surgery Physician
  • Flowood, MS
National Provider Identifier
1740318666
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MISSISSIPPI BREAST CENTER PLLC
Practice address
1030 N Flowood Dr
Suite C
Flowood, MS 39232-9532
Phone
(601) 932-7465
Fax
(601) 932-7425
NPI assigned
Mar 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

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

Authorized official

Name
Mr. Terry Hickman, CPA
Title
Office Administrator
Phone
(601) 948-1411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

1030 N Flowood Dr
Suite C
Flowood, MS 39232-9532

Mailing address

1030 N Flowood Dr
Suite C
Flowood, MS 39232-9532
Phone (601) 932-7465

Other identifiers 1

IdentifierTypeStateIssuer
09012031MedicaidMS

National Provider Directory

National Provider Directory

Locations

1030 N Flowood Dr
#C
Flowood, MS 39232
Phone (601) 932-7465

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1740318666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 N FLOWOOD DR",
            "address_2": "SUITE C",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329532",
            "telephone_number": "601-932-7465",
            "fax_number": "601-932-7425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 N FLOWOOD DR",
            "address_2": "SUITE C",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329532",
            "telephone_number": "601-932-7465",
            "fax_number": "601-932-7425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI BREAST CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "HICKMAN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "601-948-1411",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09012031",
            "state": "MS"
        }
    ],
    "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 Jun 18, 2008; 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.