Basic Information
| Provider Information | |||||||||
| NPI: | 1609409440 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RELIAS EMERGENCY MEDICINE SPECIALISTS OF HATTIESBURG LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30275 | ||||||||
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| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282300275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6624324106 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6051 U S HIGHWAY 49 | ||||||||
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| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394017200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6624324106 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2020 | ||||||||
| LastUpdateDate: | 07/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | WEST | ||||||||
| AuthorizedOfficialFirstName: | LUKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6626358383 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.