Provider Demographics
NPI:1083643761
Name:J.C. PASSMAN MDPA
Entity Type:Organization
Organization Name:J.C. PASSMAN MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:HAIMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-442-9654
Mailing Address - Street 1:46 SGT PRENTISS DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4792
Mailing Address - Country:US
Mailing Address - Phone:601-442-9654
Mailing Address - Fax:601-442-9790
Practice Address - Street 1:46 SGT PRENTISS DR
Practice Address - Street 2:SUITE 103
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4792
Practice Address - Country:US
Practice Address - Phone:601-442-9654
Practice Address - Fax:601-442-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05227204C00000X
MSPT0333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02831Medicare PIN
MSC02831Medicare ID - Type UnspecifiedGROUP NUMBER