Healthcare Provider Details

I. General information

NPI: 1619068723
Provider Name (Legal Business Name): SOUTH MISSISSIPPI INTRAOPERATIVE MONITORING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ASBURY CIR
HATTIESBURG MS
39402-1302
US

IV. Provider business mailing address

101 ASBURY CIR
HATTIESBURG MS
39402-1302
US

V. Phone/Fax

Practice location:
  • Phone: 601-450-8000
  • Fax: 601-450-8009
Mailing address:
  • Phone: 601-450-8000
  • Fax: 601-450-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number09945
License Number StateMS

VIII. Authorized Official

Name: KURT F BRUCHMEIER
Title or Position: DOCTOR
Credential: M D
Phone: 601-268-5200