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General NPI Number Information
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NPI Number | 1376733154
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Entity Type | Organization
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Legal Business Name | NBHC GULFPORT MS
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 07/27/2007
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Provider Practice Location Address
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Address Line | 5301 BAINBRIDGE AVE
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City | GULFPORT
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State | MS
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Zip | 39501-9026
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Country | US
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Telephone | 361-739-2637
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 BAINBRIDGE AVE
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City | GULFPORT
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State | MS
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Zip | 39501-9026
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Country | US
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Telephone | 361-739-2637
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Fax |
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Authorized Official
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Title or Position | IDC
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Name | GREG ALLAN LASSITER
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Credential | IDC
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Telephone | 361-739-2637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2865X1600X
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Taxonomy Name | Operational (Transportable) Military General Acute Care Hospital
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License Number |
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License Number State |
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