Provider Demographics
NPI:1598879009
Name:DIGESTIVE DISEASES CENTER OF HATTIESBURG, LLC
Entity Type:Organization
Organization Name:DIGESTIVE DISEASES CENTER OF HATTIESBURG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-268-5189
Mailing Address - Street 1:100 METHODIST HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1295
Mailing Address - Country:US
Mailing Address - Phone:601-268-5189
Mailing Address - Fax:601-268-5006
Practice Address - Street 1:1000 TURTLE CREEK DR STE 4
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1173
Practice Address - Country:US
Practice Address - Phone:601-268-5189
Practice Address - Fax:601-268-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02358833Medicaid
MSP00138452OtherRAILROAD MEDICARE
MS02358833Medicaid