Healthcare Provider Details

I. General information

NPI: 1023770625
Provider Name (Legal Business Name): OCHSNER MISSISSIPPI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 CRISWELL AVE
PASCAGOULA MS
39567-1143
US

IV. Provider business mailing address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

V. Phone/Fax

Practice location:
  • Phone: 228-762-0713
  • Fax: 228-769-7484
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO BENITEZ
Title or Position: DIRECTOR
Credential:
Phone: 504-430-0025