Provider Demographics
NPI:1275890014
Name:PHYSICIANS CARE PLAZA
Entity Type:Organization
Organization Name:PHYSICIANS CARE PLAZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:PICOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-865-9898
Mailing Address - Street 1:4310 CHICOT ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-4700
Mailing Address - Country:US
Mailing Address - Phone:228-205-0617
Mailing Address - Fax:228-205-0493
Practice Address - Street 1:4310 CHICOT ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-4700
Practice Address - Country:US
Practice Address - Phone:228-205-0617
Practice Address - Fax:228-205-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies