Healthcare Provider Details

I. General information

NPI: 1619200318
Provider Name (Legal Business Name): BILOXI URGENT CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2009
Last Update Date: 09/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LAMEUSE ST
BILOXI MS
39530-3107
US

IV. Provider business mailing address

201 LAMEUSE ST
BILOXI MS
39530-3107
US

V. Phone/Fax

Practice location:
  • Phone: 228-374-7888
  • Fax:
Mailing address:
  • Phone: 228-374-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number09295
License Number StateMS

VIII. Authorized Official

Name: PHILLIP L BARNES
Title or Position: OWNER
Credential: D.O.
Phone: 228-374-7888