| Tylertown Surgical Associates | |
|
250 Hospital Dr Tylertown MS 39667-2020 | |
| (601) 876-4961 | |
| (601) 876-9172 |
| Full Name | Tylertown Surgical Associates |
|---|---|
| Speciality | Clinic/center |
| Location | 250 Hospital Dr, Tylertown, Mississippi |
| Authorized Official Name and Position | Posavanike S Ganaraj (PRESIDENT) |
| Authorized Official Contact | 6018764961 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tylertown Surgical Associates 250 Hospital Dr P.0. Box 465 Tylertown MS 39667-2020 Ph: (601) 876-4961 | Tylertown Surgical Associates 250 Hospital Dr Tylertown MS 39667-2020 Ph: (601) 876-4961 |
| NPI Number | 1114030129 |
|---|---|
| Provider Enumeration Date | 08/16/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114030129 | NPI | - | NPPES |
| 09016259 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 07415 (Mississippi) | Primary |
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