Provider Demographics
NPI:1952411217
Name:MCCOMB OG-GYN ASSOCIATED
Entity Type:Organization
Organization Name:MCCOMB OG-GYN ASSOCIATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:REMELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-684-9116
Mailing Address - Street 1:PO BOX 1348
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-1348
Mailing Address - Country:US
Mailing Address - Phone:601-684-9116
Mailing Address - Fax:601-684-9126
Practice Address - Street 1:205 MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2705
Practice Address - Country:US
Practice Address - Phone:601-684-9116
Practice Address - Fax:601-684-9126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSCJ3236OtherRAILROAD MEDICARE
MS09015836Medicaid
MSC02645Medicare PIN