Healthcare Provider Details

I. General information

NPI: 1639621675
Provider Name (Legal Business Name): PAS-POINT FAMILY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3736 MAIN ST
MOSS POINT MS
39563-5108
US

IV. Provider business mailing address

3736 MAIN ST P.O. BOX 8572
MOSS POINT MS
39563-5108
US

V. Phone/Fax

Practice location:
  • Phone: 228-474-2242
  • Fax: 228-475-6271
Mailing address:
  • Phone: 228-474-2242
  • Fax: 228-475-6271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number17210
License Number StateMS

VIII. Authorized Official

Name: DUNK A ELLIS III
Title or Position: OWNER
Credential: MD
Phone: 228-474-2212