Provider Demographics
NPI:1023477080
Name:HEALTHSTOP LLC
Entity type:Organization
Organization Name:HEALTHSTOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LILY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAKISH
Authorized Official - Suffix:
Authorized Official - Credentials:CCRC, MBA
Authorized Official - Phone:251-455-4192
Mailing Address - Street 1:2490 PASS RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2838
Mailing Address - Country:US
Mailing Address - Phone:228-207-9967
Mailing Address - Fax:228-273-1532
Practice Address - Street 1:2490 PASS RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2838
Practice Address - Country:US
Practice Address - Phone:228-207-9967
Practice Address - Fax:228-273-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1053407148Medicare NSC
FL1053407148Medicare NSC