Ear Nose And Throat Surgical Group

LBN: Ear Nose And Throat Surgical Group
Ear Nose And Throat Surgical Group is an health care organization with primary practice located at 970 Lakeland Dr Ste 40 , Jackson MS 39216-4640. The organization recently has only one registered license in Other Service Providers / Specialist, which is considered as the primary health care specialty. Ear Nose And Throat Surgical Group can be contacted via phone (601) 200-4850, or through Wallace, Mickey P via phone (601) 898-7000.

Contact Information

Primary practice address
970 Lakeland Dr Ste 40 Jackson MS 39216-4640
Phone: (601) 200-4850
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Wallace, Mickey P Doctor of Medicine (MD)
Phone: (601) 898-7000

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 08819 Mississippi

Profile Details

NPI number 1699810069
LBN Legal business name Ear Nose And Throat Surgical Group
DBA Doing business as
Authorized official Wallace, Mickey P Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Feb 21st, 2007
Last updated Aug 10th, 2011 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699810069 NPPES
Mississippi MEDICAID 04387064

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