Provider Demographics
NPI:1902832207
Name:REGIONAL DIGESTIVE SPECIALISTS P.C.
Entity Type:Organization
Organization Name:REGIONAL DIGESTIVE SPECIALISTS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:TIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-875-3033
Mailing Address - Street 1:4511 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5336
Mailing Address - Country:US
Mailing Address - Phone:228-769-7791
Mailing Address - Fax:228-769-7747
Practice Address - Street 1:1270 OCEAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3421
Practice Address - Country:US
Practice Address - Phone:228-875-3033
Practice Address - Fax:228-875-3989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9014645Medicaid