Provider Demographics
NPI:1821204736
Name:MISSISSIPPI EAR, NOSE AND THROAT SURGICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MISSISSIPPI EAR, NOSE AND THROAT SURGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PEYTON
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-571-7129
Mailing Address - Street 1:2550 FLOWOOD DR STE 303
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9306
Mailing Address - Country:US
Mailing Address - Phone:601-709-7700
Mailing Address - Fax:601-709-7701
Practice Address - Street 1:161 RIVER OAKS DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110
Practice Address - Country:US
Practice Address - Phone:601-709-7700
Practice Address - Fax:601-709-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023455169OtherNPI
MS02652740Medicaid