Provider Demographics
NPI:1780804351
Name:SPINE MEDICAL CENTER OF JACKSON
Entity type:Organization
Organization Name:SPINE MEDICAL CENTER OF JACKSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:TUCK
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-948-8293
Mailing Address - Street 1:PO BOX 2156
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39505-2156
Mailing Address - Country:US
Mailing Address - Phone:228-865-4731
Mailing Address - Fax:228-863-5616
Practice Address - Street 1:1151 N STATE ST
Practice Address - Street 2:SUITE 508
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2407
Practice Address - Country:US
Practice Address - Phone:601-948-8293
Practice Address - Fax:601-948-8296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10893208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty