Provider Demographics
NPI:1700830494
Name:NEIGHBORHOOD HEALTHCARE PROVIDERS
Entity Type:Organization
Organization Name:NEIGHBORHOOD HEALTHCARE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AKWASI
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMPONSAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-582-5805
Mailing Address - Street 1:PO BOX 15613
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-5613
Mailing Address - Country:US
Mailing Address - Phone:601-582-5805
Mailing Address - Fax:601-582-5806
Practice Address - Street 1:2503 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-1073
Practice Address - Country:US
Practice Address - Phone:601-582-5805
Practice Address - Fax:601-582-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17488207R00000X, 2083P0901X
MS14600207R00000X, 207RC0200X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125127Medicaid
MS6785720001Medicare NSC
MS110001970Medicare PIN