Provider Demographics
NPI:1821441080
Name:AMORY SURGERY CLINIC, PLLC
Entity Type:Organization
Organization Name:AMORY SURGERY CLINIC, PLLC
Other - Org Name:AMORY SURGERY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOAT
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-256-3333
Mailing Address - Street 1:1127 EARL FRYE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5516
Mailing Address - Country:US
Mailing Address - Phone:662-256-3333
Mailing Address - Fax:662-256-5166
Practice Address - Street 1:1127 EARL FRYE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5516
Practice Address - Country:US
Practice Address - Phone:662-256-3333
Practice Address - Fax:662-256-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16728208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
020000387Medicare PIN
1114008703OtherNPI
MS00122154Medicaid