Provider Demographics
NPI:1770732570
Name:TERESA E. KLAINER,M.D.,PLLC
Entity type:Organization
Organization Name:TERESA E. KLAINER,M.D.,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:KLAINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-799-3011
Mailing Address - Street 1:1018 SIXTH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3837
Mailing Address - Country:US
Mailing Address - Phone:601-799-3011
Mailing Address - Fax:601-799-4586
Practice Address - Street 1:1018 SIXTH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3837
Practice Address - Country:US
Practice Address - Phone:601-799-3011
Practice Address - Fax:601-799-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20311208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1540668Medicaid
LAG72145Medicare UPIN
LA1540668Medicaid