Provider Demographics
NPI:1871741736
Name:BAPTIST AND PHYSICIANS OUTPATIENT SURGERY CENTER OF NORTH MS, LP
Entity type:Organization
Organization Name:BAPTIST AND PHYSICIANS OUTPATIENT SURGERY CENTER OF NORTH MS, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRYE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-234-7979
Mailing Address - Street 1:PO BOX 3488
Mailing Address - Street 2:DEPT 05-003
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803
Mailing Address - Country:US
Mailing Address - Phone:334-386-2053
Mailing Address - Fax:334-244-1830
Practice Address - Street 1:499 AZALEA DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-7901
Practice Address - Country:US
Practice Address - Phone:334-386-2053
Practice Address - Fax:334-244-1830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST AND PHYSICIANS OUTPATIENT SURGERY CENTER, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016218Medicaid
MSDF8526OtherRAILROAD MEDICARE
MS09016218Medicaid