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General NPI Number Information
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NPI Number | 1104829597
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Entity Type | Organization
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Legal Business Name | HOGAN SURGICAL CENTER PA
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 351 COWAN RD
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City | GULFPORT
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State | MS
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Zip | 39507-2019
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Country | US
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Telephone | 228-896-1120
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Fax | 228-896-1332
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Provider Business Mailing Address
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Address Line | 351 COWAN RD
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City | GULFPORT
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State | MS
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Zip | 39507-2019
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Country | US
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Telephone | 228-896-1120
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Fax | 228-896-1332
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIPER C NELSON
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Credential | MD
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Telephone | 228-896-1120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 25C0001038
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License Number State | MS
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