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General NPI Number Information
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NPI Number | 1619068723
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Entity Type | Organization
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Legal Business Name | SOUTH MISSISSIPPI INTRAOPERATIVE MONITORING, LLC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 ASBURY CIR
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City | HATTIESBURG
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State | MS
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Zip | 39402-1302
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Country | US
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Telephone | 601-450-8000
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Fax | 601-450-8009
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Provider Business Mailing Address
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Address Line | 101 ASBURY CIR
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City | HATTIESBURG
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State | MS
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Zip | 39402-1302
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Country | US
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Telephone | 601-450-8000
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Fax | 601-450-8009
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Authorized Official
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Title or Position | DOCTOR
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Name | KURT F BRUCHMEIER
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Credential | M D
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Telephone | 601-268-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 09945
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License Number State | MS
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