=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770790214
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JACKSON EAR, NOSE AND THROAT PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2007
-----------------------------------------------------
Last Update Date | 12/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1421 N STATE ST SUITE 402
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39202-1658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-352-7655
-----------------------------------------------------
Fax | 601-352-7658
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1421 N STATE ST SUITE 402
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39202-1658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-352-7655
-----------------------------------------------------
Fax | 601-352-7658
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. WILLIAM F SNEED
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 601-352-7655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 07717
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------