=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770732570
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TERESA E. KLAINER,M.D.,PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2008
-----------------------------------------------------
Last Update Date | 10/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1018 SIXTH AVE SUITE B
-----------------------------------------------------
City | PICAYUNE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39466-3837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-799-3011
-----------------------------------------------------
Fax | 601-799-4586
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1018 SIXTH AVE SUITE B
-----------------------------------------------------
City | PICAYUNE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39466-3837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-799-3011
-----------------------------------------------------
Fax | 601-799-4586
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OFFICER
-----------------------------------------------------
Name | TERESA ELENA KLAINER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 601-799-3011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 20311
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------