Provider Demographics
NPI:1821268236
Name:WHITEHAVEN OB-GYN, P.C.
Entity Type:Organization
Organization Name:WHITEHAVEN OB-GYN, P.C.
Other - Org Name:LANCE D. WHALEY, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GASKILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-349-7045
Mailing Address - Street 1:60 PHYSICIANS LN STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6122
Mailing Address - Country:US
Mailing Address - Phone:662-349-7045
Mailing Address - Fax:662-349-7048
Practice Address - Street 1:60 PHYSICIANS LN STE 2
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6122
Practice Address - Country:US
Practice Address - Phone:662-349-7045
Practice Address - Fax:662-349-7048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06684174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSB90667Medicare UPIN