Provider Demographics
NPI:1336446889
Name:ADVANCED LAPAROSCOPIC SURGERY OF SOUTH WEST MISSISSIPPI PLLC
Entity Type:Organization
Organization Name:ADVANCED LAPAROSCOPIC SURGERY OF SOUTH WEST MISSISSIPPI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCGRAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-684-2481
Mailing Address - Street 1:1311 ASTON AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2825
Mailing Address - Country:US
Mailing Address - Phone:601-684-2481
Mailing Address - Fax:601-684-2488
Practice Address - Street 1:1311 ASTON AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2825
Practice Address - Country:US
Practice Address - Phone:601-684-2481
Practice Address - Fax:601-684-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21373208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty