Healthcare Provider Details

I. General information

NPI: 1306062641
Provider Name (Legal Business Name): SOUTHERN MS HEART CENTER,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 BIENVILLE BLVD STE B
OCEAN SPRINGS MS
39564-5710
US

IV. Provider business mailing address

3704 BIENVILLE BLVD STE B
OCEAN SPRINGS MS
39564-5710
US

V. Phone/Fax

Practice location:
  • Phone: 228-872-4040
  • Fax: 228-872-3612
Mailing address:
  • Phone: 228-872-4040
  • Fax: 228-872-3612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. RHONDA BONEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 228-872-4040