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General NPI Number Information
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NPI Number | 1992976088
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Entity Type | Organization
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Legal Business Name | ENDEAVOR CARDIAC & PULMONARY SERVICES, LLC
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 206 MARYLAND AVE
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City | MCCOMB
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State | MS
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Zip | 39648-3926
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Country | US
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Telephone | 601-250-4815
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Fax |
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Provider Business Mailing Address
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Address Line | 206 MARYLAND AVE
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City | MCCOMB
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State | MS
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Zip | 39648
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHARLES BATES
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Credential |
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Telephone | 601-250-4815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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