Provider Demographics
NPI:1891982435
Name:NATCHEZ REGIONAL CLINIC
Entity Type:Organization
Organization Name:NATCHEZ REGIONAL CLINIC
Other - Org Name:NATCHEZ REGIONAL CLINIC - OBGYN
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-443-2722
Mailing Address - Street 1:46 SGT. S. PRENTISS DR.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120
Mailing Address - Country:US
Mailing Address - Phone:601-442-3701
Mailing Address - Fax:601-442-4785
Practice Address - Street 1:46 SGT. S. PRENTISS DR.
Practice Address - Street 2:SUITE 201
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120
Practice Address - Country:US
Practice Address - Phone:601-442-3701
Practice Address - Fax:601-442-4785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATCHEZ REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-27
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512G700263Medicare UPIN
MS512G700263Medicare PIN