Provider Demographics
NPI:1730138231
Name:DIABETES & ENDOCRINE INSTITUTE, PLLC
Entity Type:Organization
Organization Name:DIABETES & ENDOCRINE INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIYUKTASUTH-WOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-932-1223
Mailing Address - Street 1:2610 COURTHOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9562
Mailing Address - Country:US
Mailing Address - Phone:601-932-1223
Mailing Address - Fax:601-932-1291
Practice Address - Street 1:2610 COURTHOUSE CIR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9562
Practice Address - Country:US
Practice Address - Phone:601-932-1223
Practice Address - Fax:601-932-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17286207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS545272540OtherBLUE CROSS
MS460000011Medicare ID - Type Unspecified
MS545272540OtherBLUE CROSS