Provider Demographics
NPI:1093730962
Name:W. BOYD MASSEY, M.D., P.A.
Entity Type:Organization
Organization Name:W. BOYD MASSEY, M.D., P.A.
Other - Org Name:HINDS EAR, NOSE AND THROAT CLINIC, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:W.
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-227-1695
Mailing Address - Street 1:1300 SUNSET DR
Mailing Address - Street 2:SUITE R
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4086
Mailing Address - Country:US
Mailing Address - Phone:662-227-1695
Mailing Address - Fax:662-226-6899
Practice Address - Street 1:1300 SUNSET DR
Practice Address - Street 2:SUITE R
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4086
Practice Address - Country:US
Practice Address - Phone:662-227-1695
Practice Address - Fax:662-226-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07033207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00875052Medicaid
MS00875052Medicaid