Basic Information
| Provider Information | |||||||||
| NPI: | 1194990671 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BILOXI HMA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BILOXI HMA RADIOLOGY SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 789 | ||||||||
| Address2: | |||||||||
| City: | OCEAN SPRINGS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395660789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288180563 | ||||||||
| FaxNumber: | 2288180519 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 REYNOIR ST | ||||||||
| Address2: | |||||||||
| City: | BILOXI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395304130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288180563 | ||||||||
| FaxNumber: | 2288180519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2008 | ||||||||
| LastUpdateDate: | 04/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | WHITWELL | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2288180563 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.