Provider Demographics
NPI:1376109207
Name:SOUTHWEST MISSISSIPPI ENT, LLC
Entity Type:Organization
Organization Name:SOUTHWEST MISSISSIPPI ENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-684-1250
Mailing Address - Street 1:405 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2709
Mailing Address - Country:US
Mailing Address - Phone:601-684-1250
Mailing Address - Fax:601-684-0129
Practice Address - Street 1:405 MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2709
Practice Address - Country:US
Practice Address - Phone:601-684-1250
Practice Address - Fax:601-684-0129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty