Basic Information
| Provider Information | |||||||||
| NPI: | 1144409822 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATCHEZ REGIONAL CLINIC | ||||||||
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| OtherOrganizationName: | OB GYN ASSOCIATES OF NATCHEZ | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14149 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708984149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259249827 | ||||||||
| FaxNumber: | 2259249829 | ||||||||
| Practice Location | |||||||||
| Address1: | 136 JEFFERSON DAVIS BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | NATCHEZ | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391205104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014423701 | ||||||||
| FaxNumber: | 6014424785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2007 | ||||||||
| LastUpdateDate: | 10/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | WESSELMAN | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6014432600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
No ID Information.