| Women's Pavilion Of South Mississippi | |
|
5003 Hardy St Suite 350 Hattiesburg MS 39402-1319 | |
| (601) 450-9425 | |
| Not Available |
| Full Name | Women's Pavilion Of South Mississippi |
|---|---|
| Speciality | Clinic/Center |
| Location | 5003 Hardy St, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Holley Johnson (ADMINISTRATOR) |
| Authorized Official Contact | 6014509425 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Women's Pavilion Of South Mississippi 6524 U S Highway 98 Hattiesburg MS 39402-8569 Ph: (601) 268-9393 | Women's Pavilion Of South Mississippi 5003 Hardy St Suite 350 Hattiesburg MS 39402-1319 Ph: (601) 450-9425 |
| NPI Number | 1548640642 |
|---|---|
| Provider Enumeration Date | 06/03/2015 |
| Last Update Date | 12/27/2023 |
| Medicare PECOS PAC ID | 2567497985 |
|---|---|
| Medicare Enrollment ID | O20231219002556 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548640642 | NPI | - | NPPES |
| 05439065 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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