=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376165027
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCH CARDIOLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2020
-----------------------------------------------------
Last Update Date | 10/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 HOSPITAL ROAD
-----------------------------------------------------
City | STARKVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39759-2163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-323-4320
-----------------------------------------------------
Fax | 662-615-2554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1326
-----------------------------------------------------
City | STARKVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39760-1326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-615-2830
-----------------------------------------------------
Fax | 662-615-2836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MS. SUSAN H. RUSSELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-615-2550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------