Provider Demographics
NPI:1932756384
Name:PISCIOTTA MEDICAL, INC
Entity Type:Organization
Organization Name:PISCIOTTA MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-388-4585
Mailing Address - Street 1:2781 C T SWITZER SR DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4535
Mailing Address - Country:US
Mailing Address - Phone:228-388-4585
Mailing Address - Fax:228-385-7610
Practice Address - Street 1:2781 C T SWITZER SR DR STE 400
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4535
Practice Address - Country:US
Practice Address - Phone:228-388-4585
Practice Address - Fax:228-385-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123600Medicaid