Provider Demographics
NPI:1639444854
Name:SURGICAL SPECIALISTS OF MISSISSIPPI
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS OF MISSISSIPPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-234-3000
Mailing Address - Street 1:15190 COMMUNITY RD
Mailing Address - Street 2:STE 210
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3485
Mailing Address - Country:US
Mailing Address - Phone:985-234-3000
Mailing Address - Fax:
Practice Address - Street 1:15190 COMMUNITY RD
Practice Address - Street 2:STE 210
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3485
Practice Address - Country:US
Practice Address - Phone:985-234-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty