Provider Demographics
NPI:1679107825
Name:OCH HUXFORD CLINIC PULMONOLOGY SLEEP MEDICINE
Entity Type:Organization
Organization Name:OCH HUXFORD CLINIC PULMONOLOGY SLEEP MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-615-2550
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-1506
Mailing Address - Country:US
Mailing Address - Phone:662-615-2504
Mailing Address - Fax:662-615-2554
Practice Address - Street 1:307 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2155
Practice Address - Country:US
Practice Address - Phone:662-615-3721
Practice Address - Fax:662-615-3728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty