Hattiesburg Clinic, PA
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Richton, MS
NPI 1942233283 · NPPES record last updated Feb 12, 2021
Key facts
- NPI
- 1942233283
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- HATTIESBURG CLINIC, PA
- Practice address
- 303 Red Bud Avenue
Richton, MS 39476 - Phone
- (601) 788-2555
- Fax
- (601) 788-5587
- NPI assigned
- Jul 9, 2006
- Organization subpart
- No
Authorized official
- Name
- Bryan N Batson, MD
- Title
- Executive Director
- Phone
- (601) 264-6000
Corporate family (same tax ID) 18
Affiliated clinicians 4
-
Daniel M Habeeb, MD
-
Brian S Rifkin, MD
Medicare Care Compare: Dialysis facility
- Listed as
- Richton Dialysis
- Overall star rating
- ★★★☆☆ 3.0 of 5
- Ownership
- Profit
- Certified
- May 5, 2000
- Medicare certification status
- Active
- Dialysis stations
- 20
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D0970398 | Richton Dialysis Unit | Certificate of waiver | Feb 13, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101029001207 | MS | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 5193706794 | Practice locations: Richton, MS |
National Provider Directory
- Tax ID family
- Hattiesburg Clinic PA
Locations
303 Red Bud St
Richton, MS 39476
Phone (601) 788-2555
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Yes |
Addresses
Primary practice location
303 Red Bud Avenue
Richton, MS 39476
Mailing address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 788-2555
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5000477 | Other | MS | UNITED HEALTHCARE |
| 000050944 | Other | MS | BLUE CROSS BLUE SHIELD MS |
| 00220600 | Medicaid | MS |
Other names
- Richton Dialysis Unit
Other providers in Richton, MS
- Crystal Dale Grantham
- Greene Area Medical Extenders, Inc
- Robin Delain Greene-Brownlee
- Angela Denise Haigler
- Hattiesburg Clinic, PA
- Mandalynn Nichole Hession
- Erick T Hibbler
- Jill D Hickmon
- Caleb Jatrell Hinton
- Hannah Dean Inman
All providers in Richton, MS · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.