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General NPI Number Information
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NPI Number | 1821204736
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI EAR, NOSE AND THROAT SURGICAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 05/08/2021
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Provider Practice Location Address
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Address Line | 161 RIVER OAKS DRIVE SUITE 202
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City | MADISON
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State | MS
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Zip | 39110
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Country | US
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Telephone | 601-709-7700
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Fax | 601-709-7701
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Provider Business Mailing Address
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Address Line | 2550 FLOWOOD DR STE 303
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City | FLOWOOD
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State | MS
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Zip | 39232-9306
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Country | US
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Telephone | 601-709-7700
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Fax | 601-709-7701
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JOHN PEYTON HINES
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Credential | MD
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Telephone | 662-571-7129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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