Provider Demographics
NPI:1316383433
Name:MISS-LOU OB-GYN CTR,, INC
Entity Type:Organization
Organization Name:MISS-LOU OB-GYN CTR,, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:KUMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-304-0020
Mailing Address - Street 1:55 SGT PRENTISS DR
Mailing Address - Street 2:100
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4782
Mailing Address - Country:US
Mailing Address - Phone:601-304-0020
Mailing Address - Fax:601-304-0023
Practice Address - Street 1:55 SGT PRENTISS DR
Practice Address - Street 2:100
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4782
Practice Address - Country:US
Practice Address - Phone:601-304-0020
Practice Address - Fax:601-304-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15330261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118246Medicaid
MSG41132Medicare UPIN
MS160000418Medicare PIN