Provider Demographics
NPI:1609296037
Name:HUGO C. NIEVAS, MD, PA
Entity Type:Organization
Organization Name:HUGO C. NIEVAS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:HUGO
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:NIEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-860-3467
Mailing Address - Street 1:PO BOX 1628
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1628
Mailing Address - Country:US
Mailing Address - Phone:228-860-3467
Mailing Address - Fax:985-643-9808
Practice Address - Street 1:1017 44TH AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2547
Practice Address - Country:US
Practice Address - Phone:228-860-3467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08451207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122342Medicaid
MS00122342Medicaid
MS348810Medicare PIN