Healthcare Provider Details

I. General information

NPI: 1346848694
Provider Name (Legal Business Name): HAYCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 BROOKMAN DR
BROOKHAVEN MS
39601-2326
US

IV. Provider business mailing address

PO BOX 620
BROOKHAVEN MS
39602-0620
US

V. Phone/Fax

Practice location:
  • Phone: 601-757-3259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM STANLEY HAY
Title or Position: OWNER
Credential:
Phone: 601-833-7973