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General NPI Number Information
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NPI Number | 1891728382
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI COAST ENDOSCOPY & AMBULATORY CENTER LLC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 2406 CATALPA AVE
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City | PASCAGOULA
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State | MS
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Zip | 39567-1813
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Country | US
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Telephone | 228-696-0818
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Fax | 228-696-0893
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Provider Business Mailing Address
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Address Line | 2406 CATALPA AVE
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City | PASCAGOULA
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State | MS
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Zip | 39567-1813
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Country | US
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Telephone |
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Fax | 228-696-0893
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | KATHERINE RENEE JUDKINS
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Credential |
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Telephone | 615-240-3770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 019
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License Number State | MS
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