Healthcare Provider Details

I. General information

NPI: 1558715797
Provider Name (Legal Business Name): SYNAPTIC RESOURCES GULF STATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 LAKELAND DR STE 508
JACKSON MS
39216-4852
US

IV. Provider business mailing address

PO BOX 59001 DEPARTMENT 4010
TULSA OK
74159-9001
US

V. Phone/Fax

Practice location:
  • Phone: 844-743-5552
  • Fax: 877-688-8872
Mailing address:
  • Phone: 844-743-5552
  • Fax: 877-688-8872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE THOMAS
Title or Position: COO
Credential:
Phone: 918-743-5552