Provider Demographics
NPI:1619068723
Name:SOUTH MISSISSIPPI INTRAOPERATIVE MONITORING, LLC
Entity Type:Organization
Organization Name:SOUTH MISSISSIPPI INTRAOPERATIVE MONITORING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRUCHMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:601-268-5200
Mailing Address - Street 1:101 ASBURY CIR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1302
Mailing Address - Country:US
Mailing Address - Phone:601-450-8000
Mailing Address - Fax:601-450-8009
Practice Address - Street 1:101 ASBURY CIR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1302
Practice Address - Country:US
Practice Address - Phone:601-450-8000
Practice Address - Fax:601-450-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09945173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty