Provider Demographics
NPI:1760464358
Name:MEDICAL ARTS SURGICAL GROUP
Entity Type:Organization
Organization Name:MEDICAL ARTS SURGICAL GROUP
Other - Org Name:MEDICAL ARTS SURGICAL GROUP RUSH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED/PARNTER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:BILLUPS III
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-693-3834
Mailing Address - Street 1:2111 14TH STREET
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301
Mailing Address - Country:US
Mailing Address - Phone:601-693-3834
Mailing Address - Fax:601-484-3225
Practice Address - Street 1:2111 14TH STREET
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-693-3834
Practice Address - Fax:601-484-3225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0015368Medicaid
MS0015368Medicaid