Provider Demographics
NPI:1841404985
Name:NESHOBA PHYSICIAN BILLING SERVICE
Entity Type:Organization
Organization Name:NESHOBA PHYSICIAN BILLING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-656-9460
Mailing Address - Street 1:PO BOX 976
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-0976
Mailing Address - Country:US
Mailing Address - Phone:601-656-9460
Mailing Address - Fax:601-656-2010
Practice Address - Street 1:1001 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2161
Practice Address - Country:US
Practice Address - Phone:601-656-9460
Practice Address - Fax:601-656-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016096Medicaid
MSCH9590OtherMEDICARE RAILROAD
MSCH9590OtherMEDICARE RAILROAD
MS=========AOtherBCBS