MEDICARE: THE HULL CLINIC OF GYNECOLOGY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	04683	MS

General Provider Information

NPI Number	:	1134301856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HULL CLINIC OF GYNECOLOGY

Provider Business Mailing Address
First Line	:	1044 N FLOWOOD DR
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9789
Country	:	US
Telephone Number	:	601-932-4950
Fax Number	:	601-932-2172

Provider Business Practice Location Address
First Line	:	1044 N FLOWOOD DR
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9789
Country	:	US
Telephone Number	:	601-932-4950
Fax Number	:	601-932-2172

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. SANDRA DARLENE KLAUDER
Credential	:
Telephone Number	:	601-941-5543

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	05/14/2008

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