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NPI Code Detail

MEDICARE: CLAIB CTY HSP PRO FEES

MEDICARE: CLAIB CTY HSP PRO FEES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician
2207RC0000XCardiovascular Disease Physician
3207PE0004XEmergency Medical Services (Emergency Medicine) Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4000019140OTHERMSPROF FEE

General Provider Information

NPI Number : 1558480491
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLAIB CTY HSP PRO FEES
Provider Business Mailing Address
First Line : 123 MCCOMB AVE
Second Line : P O BOX 1004
City : PORT GIBSON
State : MS
Zip : 39150-2915
Country : US
Telephone Number : 601-437-5141
Fax Number : 601-437-8547
Provider Business Practice Location Address
First Line : 123 MCCOMB AVE
Second Line :
City : PORT GIBSON
State : MS
Zip : 39150-2915
Country : US
Telephone Number : 601-437-5141
Fax Number : 601-437-8547
Authorized Official
Title or Position : CEO
Name : RAY L SHOEMAKER
Credential :
Telephone Number : 662-321-1155
Provider Enumeration Date : 03/29/2007
Last Update Date : 06/14/2010

Similar Medicare Providers

1700836350 — CLAIBORNE COUNTY HOSPITAL
Practice Location Address:
123 MCCOMB AVE
PORT GIBSON, MS
39150-2915
Practice Phone: 601-437-5141
Practice Fax: 601-437-3782
1225047863 — STUART P LEVENTHAL MD
Practice Location Address:
123 MCCOMB AVE
PORT GIBSON, MS
39150-2915
Practice Phone: 601-437-5141
Practice Fax:
1447338793 — CLAIBORNE COUNTY HOSPITAL
Practice Location Address:
123 MCCOMB AVE
PORT GIBSON, MS
39150-2915
Practice Phone: 601-437-5141
Practice Fax: 601-437-8547
1801047451 — PATIENTS CHOICE MEDICAL CENTER OF CLAIBORNE COUNTY LLC
Practice Location Address:
123 MCCOMB AVE
PORT GIBSON, MS
39150-2915
Practice Phone: 601-437-5141
Practice Fax: 601-437-3782
1003067539 — PATIENTS CHOICE MEDICAL CENTER OF CLAIBORNE COUNTY LLC
Practice Location Address:
123 MCCOMB AVE
PORT GIBSON, MS
39150-2915
Practice Phone: 601-437-5141
Practice Fax: 601-437-3782
1831340363 — PATIENTS CHOICE MEDICAL CENTER OF CLAIBORNE COUNTY LLC
Practice Location Address:
123 MCCOMB AVE
PORT GIBSON, MS
39150-2915
Practice Phone: 601-437-5141
Practice Fax: 601-437-3782

Directions to “CLAIB CTY HSP PRO FEES ” Practice Location

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