Healthcare Provider Details

I. General information

NPI: 1588535025
Provider Name (Legal Business Name): OBTELECARE MISSISSIPPI, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 13TH ST
GULFPORT MS
39501-2515
US

IV. Provider business mailing address

777 LOWNDES HILL RD BLDG 1
GREENVILLE SC
29607-2101
US

V. Phone/Fax

Practice location:
  • Phone: 864-908-3530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DENISE BURNS
Title or Position: DIRECTOR
Credential:
Phone: 864-908-3530