Provider Demographics
NPI:1326116112
Name:MISSISSIPPI NEUROSURGERY AND SPINE CENTER,PLLC
Entity Type:Organization
Organization Name:MISSISSIPPI NEUROSURGERY AND SPINE CENTER,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-936-0400
Mailing Address - Street 1:1 LAYFAIR DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9717
Mailing Address - Country:US
Mailing Address - Phone:601-936-0400
Mailing Address - Fax:601-936-0401
Practice Address - Street 1:1 LAYFAIR DR
Practice Address - Street 2:SUITE 120
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9717
Practice Address - Country:US
Practice Address - Phone:601-936-0400
Practice Address - Fax:601-936-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02684Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #