Mississippi Coast Endoscopy & Ambulatory Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

019 Issued in MS

Legal business name

MISSISSIPPI COAST ENDOSCOPY & AMBULATORY CENTER LLC

Practice address

2406 Catalpa Ave
Pascagoula, MS 39567-1813

Phone

(228) 696-0818

Fax

(228) 696-0893

NPI assigned

Jul 8, 2006

Organization subpart

No

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

Authorized official

Name

Katherine Renee Judkins

Title

Vice President

Phone

(615) 240-3770

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Mississippi Coast Endoscopy & Ambulatory Surgical Doing business as

Listed as

Mississippi Coast Endoscopy and Ambulatory Center LLCCCN 25C0001035

Medicare certification status

Terminated Voluntary: merger or closure, May 31, 2025From the Provider of Services file

Practitioners 1

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

• Mark S Lyell, MD

  • Urology Physician
  • Ocean Springs, MS
  • NPI 1407861776
  NPD

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674777600000",
    "number": "1891728382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2406 CATALPA AVE",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395671813",
            "fax_number": "228-696-0893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2406 CATALPA AVE",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395671813",
            "telephone_number": "228-696-0818",
            "fax_number": "228-696-0893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI COAST ENDOSCOPY & AMBULATORY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A",
        "authorized_official_last_name": "JUDKINS",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "615-240-3770"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MS",
            "license": "019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000050466",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0770544",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR",
            "identifier": "169127800",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490005347",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mississippi Coast Endoscopy & Ambulatory Surgical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laird Miller
• Pamela Jane Kensler Miller, RN
• Terrence John Millette, MD
• Theodore Michael Millette, M. D.
• Tyshayla Mimbes
• Mississippi Coast Urology
• Mississippi Coastal MRI LLC
• Mississippi CVS Pharmacy, L.L.C.
• Mississippi Emergency Department Services PC
• Mississippi Family Health Care Center PA

• Ambulatory Surgical Clinic/Center in Pascagoula, MS
• Providers in Pascagoula, MS by specialty
• Ambulatory Surgical Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.