Provider Demographics
NPI:1376733154
Name:NBHC GULFPORT MS
Entity Type:Organization
Organization Name:NBHC GULFPORT MS
Other - Org Name:NBHC GULPORT MS
Other - Org Type:Other Name
Authorized Official - Title/Position:IDC
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:IDC
Authorized Official - Phone:361-739-2637
Mailing Address - Street 1:5301 BAINBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-9026
Mailing Address - Country:US
Mailing Address - Phone:361-739-2637
Mailing Address - Fax:
Practice Address - Street 1:5301 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-9026
Practice Address - Country:US
Practice Address - Phone:361-739-2637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865X1600XHospitalsMilitary HospitalMilitary General Acute Care Hospital. Operational (Transportable)