NPI Code Detail JSON Logo

1003720053 NPI number — WOUND MANAGEMENT AND VASCULAR SURGERY CENTER AT STONE CREEK LLC

NPI Number: 1003720053
Health Care Provider/Practitioner: WOUND MANAGEMENT AND VASCULAR SURGERY CENTER AT STONE CREEK LLC

Information about “1003720053” NPI (WOUND MANAGEMENT AND VASCULAR SURGERY CENTER AT STONE CREEK LLC) exists in 1003720053 in HTML format HTML  |  1003720053 in plain Text format TXT  |  1003720053 in PDF (Portable Document Format) PDF  |  1003720053 in an XML format XML  formats.

NPI Number : 1003720053 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003720053",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WOUND MANAGEMENT AND VASCULAR SURGERY CENTER AT STONE CREEK LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "778 LIBERTY RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FLOWOOD",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "39232-9321",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "769-243-6141",
    "MailingAddressFaxNumber": "601-510-1665",
    "FirstLinePracticeLocationAddress": "120 STONE CREEK BLVD STE 800",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FLOWOOD",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39232-8205",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "769-243-6141",
    "PracticeLocationAddressFaxNumber": "601-510-1665",
    "EnumerationDate": "09/29/2026",
    "LastUpdateDate": "09/29/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GRIFFIN",
    "AuthorizedOfficialFirstName": "LACHELLE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CHRO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "769-208-4437",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208600000X",
        "TaxonomyName": "Surgery Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "NULL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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