| |
1110 Broad Ave Suite 700 Gulfport MS 39501-8907 | |
(228) 864-0314 | |
(228) 864-0425 |
Full Name | |
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Speciality | Internal Medicine |
Location | 1110 Broad Ave, Gulfport, Mississippi |
Authorized Official Name and Position | Jeff T Steiner (VP OF FINANCE) |
Authorized Official Contact | 2288653106 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 555 Biloxi MS 39533-0555 Ph: (228) 864-0854 | 1110 Broad Ave Suite 700 Gulfport MS 39501-8907 Ph: (228) 864-0314 |
NPI Number | 1063744704 |
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Provider Enumeration Date | 02/05/2010 |
Last Update Date | 01/03/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1063744704 | NPI | - | NPPES |
09014379 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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