Healthcare Provider Details

I. General information

NPI: 1447249354
Provider Name (Legal Business Name): GASTROINTESTINAL ENDOSCOPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 N STATE ST SUITE 300
JACKSON MS
39202-1642
US

IV. Provider business mailing address

1405 N STATE ST SUITE 300
JACKSON MS
39202-1642
US

V. Phone/Fax

Practice location:
  • Phone: 601-355-1234
  • Fax: 601-354-3881
Mailing address:
  • Phone: 601-355-1234
  • Fax: 601-354-3881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: REED B HOGAN
Title or Position: PRESIDENT OF CORP
Credential: MD
Phone: 601-355-1234