Provider Demographics
NPI:1629395769
Name:THE UNIVERSITY OF SOUTHERN MISSISSIPPI
Entity Type:Organization
Organization Name:THE UNIVERSITY OF SOUTHERN MISSISSIPPI
Other - Org Name:UNIVERSITY OF SOUTHERN MISSISSIPPI APPLIED HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEAN OF THE COLLEGE OF HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-266-4866
Mailing Address - Street 1:118 COLLEGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39406-0001
Mailing Address - Country:US
Mailing Address - Phone:601-266-4866
Mailing Address - Fax:601-266-5790
Practice Address - Street 1:118 COLLEGE DRIVE
Practice Address - Street 2:#5092
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39406-0001
Practice Address - Country:US
Practice Address - Phone:601-266-5216
Practice Address - Fax:601-266-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA0454231H00000X
MSA3282237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty