Healthcare Provider Details

I. General information

NPI: 1952405201
Provider Name (Legal Business Name): BAY ST. LOUIS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202A DRINKWATER BLVD
BAY ST LOUIS MS
39520
US

IV. Provider business mailing address

202A DRINKWATER BLVD
BAY ST LOUIS MS
39520
US

V. Phone/Fax

Practice location:
  • Phone: 228-467-2200
  • Fax: 228-467-2211
Mailing address:
  • Phone: 228-467-2200
  • Fax: 228-467-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18394
License Number StateMS

VIII. Authorized Official

Name: DR. SCOTT NEEDLE
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 228-467-2200