Provider Demographics
NPI:1518075720
Name:A KEITH LAY JR MD
Entity Type:Organization
Organization Name:A KEITH LAY JR MD
Other - Org Name:BAY SPRINGS AFTER HOURS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAY
Authorized Official - Suffix:
Authorized Official - Credentials:AUTHORIZED OFFICIAL
Authorized Official - Phone:601-670-6295
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:433 HWY 18
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422-0549
Mailing Address - Country:US
Mailing Address - Phone:601-764-2155
Mailing Address - Fax:601-764-9667
Practice Address - Street 1:27 S SIXTH ST
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-9052
Practice Address - Country:US
Practice Address - Phone:601-764-2143
Practice Address - Fax:601-764-4890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS253885Medicare Oscar/Certification
MS253885Medicare PIN