=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932357498
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER ORTHOPAEDICS AND SPORTS MEDICINE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2008
-----------------------------------------------------
Last Update Date | 01/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5003 HARDY ST STE 401
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39402-1331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-296-2100
-----------------------------------------------------
Fax | 601-296-2106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5003 HARDY ST STE 401
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39402-1331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-296-2100
-----------------------------------------------------
Fax | 601-296-2106
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | THOMAS B. BAYLIS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 601-310-5285
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------