Healthcare Provider Details

I. General information

NPI: 1821204736
Provider Name (Legal Business Name): MISSISSIPPI EAR, NOSE AND THROAT SURGICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 05/08/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 RIVER OAKS DRIVE SUITE 202
MADISON MS
39110
US

IV. Provider business mailing address

2550 FLOWOOD DR STE 303
FLOWOOD MS
39232-9306
US

V. Phone/Fax

Practice location:
  • Phone: 601-709-7700
  • Fax: 601-709-7701
Mailing address:
  • Phone: 601-709-7700
  • Fax: 601-709-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN PEYTON HINES
Title or Position: PHYSICIAN
Credential: MD
Phone: 662-571-7129