Provider Demographics
NPI:1134301856
Name:THE HULL CLINIC OF GYNECOLOGY
Entity Type:Organization
Organization Name:THE HULL CLINIC OF GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:KLAUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-941-5543
Mailing Address - Street 1:1044 N FLOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9789
Mailing Address - Country:US
Mailing Address - Phone:601-932-4950
Mailing Address - Fax:601-932-2172
Practice Address - Street 1:1044 N FLOWOOD DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9789
Practice Address - Country:US
Practice Address - Phone:601-932-4950
Practice Address - Fax:601-932-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04683207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSD80630Medicare UPIN