Healthcare Provider Details

I. General information

NPI: 1396015087
Provider Name (Legal Business Name): ST MICHAEL URGENT CARE OF HATTIESBURG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 HARDY ST
HATTIESBURG MS
39402-1553
US

IV. Provider business mailing address

3700 HARDY ST
HATTIESBURG MS
39402-1553
US

V. Phone/Fax

Practice location:
  • Phone: 601-544-7012
  • Fax: 601-544-7013
Mailing address:
  • Phone: 601-544-7012
  • Fax: 601-544-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number19875
License Number StateMS

VIII. Authorized Official

Name: DR. IKECHUKWU H OKORIE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 601-544-7012