Provider Demographics
NPI:1689851479
Name:THE SURGICAL CLINIC
Entity Type:Organization
Organization Name:THE SURGICAL CLINIC
Other - Org Name:ADKINS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-861-6049
Mailing Address - Street 1:2533 MERCEDES DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2813
Mailing Address - Country:US
Mailing Address - Phone:228-388-3020
Mailing Address - Fax:228-392-9035
Practice Address - Street 1:11516 LAMEY BRIDGE RD STE I
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-2725
Practice Address - Country:US
Practice Address - Phone:228-207-4190
Practice Address - Fax:228-207-4156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00012155Medicaid
MS00012155Medicaid