Provider Demographics
NPI:1013961580
Name:PHYSICIAN AND SURGEONS HOSPITAL GROUP
Entity Type:Organization
Organization Name:PHYSICIAN AND SURGEONS HOSPITAL GROUP
Other - Org Name:TRI LAKES WOMEN CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-712-2371
Mailing Address - Street 1:303 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606
Mailing Address - Country:US
Mailing Address - Phone:662-578-8262
Mailing Address - Fax:662-578-7969
Practice Address - Street 1:303 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606
Practice Address - Country:US
Practice Address - Phone:662-578-8262
Practice Address - Fax:662-578-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS258517Medicare ID - Type UnspecifiedCO1050