Provider Demographics
NPI:1578719225
Name:ORTHOPAEDIC CLINICS OF SW MISSISSIPPI PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC CLINICS OF SW MISSISSIPPI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JEFFCOAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-684-4613
Mailing Address - Street 1:300 RAWLS DR
Mailing Address - Street 2:MEDICAL ARTS BUILDING SUITE 400
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2877
Mailing Address - Country:US
Mailing Address - Phone:601-684-4613
Mailing Address - Fax:601-249-2287
Practice Address - Street 1:300 RAWLS DR
Practice Address - Street 2:MEDICAL ARTS BUILDING SUITE 400
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2877
Practice Address - Country:US
Practice Address - Phone:601-684-4613
Practice Address - Fax:601-249-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06737174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200000341Medicare PIN
MSB30245Medicare UPIN