Provider Demographics
NPI:1063647956
Name:BILOXI OBGYN CLINIC, PA
Entity Type:Organization
Organization Name:BILOXI OBGYN CLINIC, PA
Other - Org Name:BILOXI OBGYN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-436-6658
Mailing Address - Street 1:2429 W COMMERCE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3114
Mailing Address - Country:US
Mailing Address - Phone:228-875-0485
Mailing Address - Fax:
Practice Address - Street 1:2429 W COMMERCE ST
Practice Address - Street 2:SUITE A
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3114
Practice Address - Country:US
Practice Address - Phone:228-875-0485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC00958Medicare PIN