Provider Demographics
NPI:1255367736
Name:SOUTH MISSISSIPPI HEART AND VASCULAR INSTITUTE PLLC
Entity type:Organization
Organization Name:SOUTH MISSISSIPPI HEART AND VASCULAR INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:I
Authorized Official - Last Name:AWAAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-343-4057
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-0399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1104 BROAD AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2414
Practice Address - Country:US
Practice Address - Phone:228-343-4057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18345174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty