Provider Demographics
NPI:1639437411
Name:BIENVILLE MEDICAL CLINIC, PLLC
Entity Type:Organization
Organization Name:BIENVILLE MEDICAL CLINIC, PLLC
Other - Org Name:WILLIAM L. STRIEGEL, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT - SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:STRIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-266-2208
Mailing Address - Street 1:11 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5709
Mailing Address - Country:US
Mailing Address - Phone:228-266-2208
Mailing Address - Fax:228-875-1335
Practice Address - Street 1:11 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5709
Practice Address - Country:US
Practice Address - Phone:228-266-2208
Practice Address - Fax:228-875-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10164174400000X
174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07136551Medicaid
MS10164OtherMEDICAL LICENSE
ME1639437411OtherBILLING NPI
MS00012035Medicaid
MS1205947843OtherTYPE 1-INDIVIDUAL NPI
MS25D0319779OtherCLIA NUMBER