Basic Information
| Provider Information | |||||||||
| NPI: | 1336446889 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED LAPAROSCOPIC SURGERY OF SOUTH WEST MISSISSIPPI PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1311 ASTON AVE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396482825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842481 | ||||||||
| FaxNumber: | 6016842488 | ||||||||
| Practice Location | |||||||||
| Address1: | 1311 ASTON AVE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396482825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842481 | ||||||||
| FaxNumber: | 6016842488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2011 | ||||||||
| LastUpdateDate: | 02/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | MCGRAW | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6016842481 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 21373 | MS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.