Provider Demographics
NPI:1821204108
Name:NATCHEZ THORACIC,VASCULAR AND SURGERY CLINIC
Entity Type:Organization
Organization Name:NATCHEZ THORACIC,VASCULAR AND SURGERY CLINIC
Other - Org Name:NATCHEZ REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:SCOT
Authorized Official - Last Name:RUBENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACS
Authorized Official - Phone:601-446-6068
Mailing Address - Street 1:PO BOX 14149
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898-4149
Mailing Address - Country:US
Mailing Address - Phone:225-924-9827
Mailing Address - Fax:225-924-9829
Practice Address - Street 1:46 SERGEANT PRENTISS DR
Practice Address - Street 2:SUITE 203
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4792
Practice Address - Country:US
Practice Address - Phone:601-446-6068
Practice Address - Fax:601-446-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19606174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548281926OtherNPI
1548281926OtherNPI
MSC02567Medicare Oscar/Certification
MSC02567Medicare PIN
1548281926OtherNPI