Healthcare Provider Details

I. General information

NPI: 1962688358
Provider Name (Legal Business Name): PSCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FRANKLIN RD
HATTIESBURG MS
39402-1318
US

IV. Provider business mailing address

40 FRANKLIN RD
HATTIESBURG MS
39402-1318
US

V. Phone/Fax

Practice location:
  • Phone: 601-296-3405
  • Fax: 601-296-3409
Mailing address:
  • Phone: 601-296-3405
  • Fax: 601-296-3409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL J TALBOT
Title or Position: DIRECTOR
Credential: M.D.
Phone: 601-296-3405