Provider Demographics
NPI:1942754338
Name:SOUTHERN DIGESTIVE HEALTH CENTER,LLC
Entity Type:Organization
Organization Name:SOUTHERN DIGESTIVE HEALTH CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:U
Authorized Official - Last Name:ANAZIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-249-0013
Mailing Address - Street 1:101 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-2021
Mailing Address - Country:US
Mailing Address - Phone:601-827-5075
Mailing Address - Fax:601-827-5733
Practice Address - Street 1:101 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-2021
Practice Address - Country:US
Practice Address - Phone:601-827-5075
Practice Address - Fax:601-827-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAD9666895174400000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty