Provider Demographics
NPI:1295918894
Name:ENDOCRINE CARE CENTER, PLLC
Entity type:Organization
Organization Name:ENDOCRINE CARE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:W
Authorized Official - Last Name:FRIEZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-432-5200
Mailing Address - Street 1:PO BOX 7029
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-7001
Mailing Address - Country:US
Mailing Address - Phone:228-432-5200
Mailing Address - Fax:228-432-5201
Practice Address - Street 1:147 REYNOIR ST
Practice Address - Street 2:SUITE 305
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-4109
Practice Address - Country:US
Practice Address - Phone:228-432-5200
Practice Address - Fax:228-432-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19154174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06408291Medicaid
MS06408291Medicaid
I51042Medicare UPIN