Healthcare Provider Details

I. General information

NPI: 1609885532
Provider Name (Legal Business Name): OSVALDO HANS MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date: 04/17/2007
Reactivation Date: 05/22/2009

III. Provider practice location address

100 NORMAN RD
CORINTH MS
38834-9372
US

IV. Provider business mailing address

100 NORMAN RD
CORINTH MS
38834-9372
US

V. Phone/Fax

Practice location:
  • Phone: 662-286-6997
  • Fax: 662-286-6148
Mailing address:
  • Phone: 662-286-6997
  • Fax: 662-286-6148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number09558
License Number StateMS

VIII. Authorized Official

Name: DONALD R LLOYD
Title or Position: CHIEF OF PHYSICIAN OPERATIONS
Credential:
Phone: 662-287-6913