| Asa Llc | |
|
1924 30th Ave Gulfport MS 39501-4534 | |
| (228) 343-3044 | |
| (228) 206-4523 |
| Full Name | Asa Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1924 30th Ave, Gulfport, Mississippi |
| Authorized Official Name and Position | Robert Lee Gillum (SURGICAL ASSISTANT) |
| Authorized Official Contact | 2283433044 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Asa Llc 1924 30th Ave Gulfport MS 39501-4534 Ph: (228) 343-3044 | Asa Llc 1924 30th Ave Gulfport MS 39501-4534 Ph: (228) 343-3044 |
| NPI Number | 1558897744 |
|---|---|
| Provider Enumeration Date | 05/07/2017 |
| Last Update Date | 05/07/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558897744 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (Mississippi) | Primary |
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