MEMORIAL HOSPITAL AT GULFPORT (NPI# 1043408339) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043408339 |
| Entity Type | Organization |
| Organization Name | MEMORIAL HOSPITAL AT GULFPORT |
| Other Organization Name | ORTHOPEDICS AT MHG |
| Practice Address |
1340 Broad Ave Suite 450 Gulfport MS 39501-2404 |
| Mailing Address |
Po Box 555 Biloxi MS 39533-0555 |
| Practice Telephone | 2288648454 |
| Practice Fax Number | 2288651451 |
| Mailing Telephone | 2288648454 |
| Mailing Fax Number | 2288651451 |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2008-12-11 |
| Authorized Official Name | MR. RANDY ROBINSON (ADMINISTRATOR) |
| Authorized Official Telephone | 2288651453 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | 16601 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 06720281 | 05 | |
| MS | 01724318 | 05 |
| Other Name | Type Code |
|---|---|
| ORTHOPEDICS at MHG | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215354402 | Memorial Hospital At Gulfport | Physical Therapy Assistant | 2781 C.t. Switzer, Suite 404, Biloxi, MS 39531 | 2014-03-25 |
| 1609203173 | Memorial Hospital At Gulfport | Internal Medicine | 1756 Popps Ferry Rd Ste A, Biloxi, MS 39532-2118 | 2013-09-30 |
| 1285070672 | Memorial Hospital At Gulfport | Occupational Therapist | 2781 C. T. Switzer Dr., Suite 404, Biloxi, MS 39531-4535 | 2013-05-13 |
| 1205129137 | Memorial Hospital At Gulfport | Family Medicine | 20006 Hwy 53, 7 Sunshine Place, Gulfport, MS 39503-0000 | 2011-05-25 |
| 1275848889 | Memorial Hospital At Gulfport | Internal Medicine | 4405 E Aloha Dr, Suite 1, Diamondhead, MS 39525-3380 | 2010-08-09 |
| 1649585258 | Memorial Hospital At Gulfport | Internal Medicine | 784 Vieux Marche Mall, Biloxi, MS 39530-3822 | 2010-08-09 |
| 1730411463 | Memorial Hospital At Gulfport | Pediatrics | 12259 Highway 49, Suite C, Gulfport, MS 39503-3063 | 2010-02-05 |
| 1649404435 | Memorial Hospital At Gulfport | Internal Medicine | 970 Tommy Munro Dr, Biloxi, MS 39532-2130 | 2009-05-07 |
| 1295978435 | Memorial Hospital At Gulfport | Psychiatry & Neurology | 5407 Indian Hill Blvd, Diamondhead, MS 39525-3324 | 2009-04-17 |
| 1255524211 | Memorial Hospital At Gulfport | Clinic/Center | 1340 Broad Ave Ste 220, Gulfport, MS 39501-2404 | 2007-08-23 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MEMORIAL HOSPITAL AT GULFPORT | 4500 13th St, Gulfport, MS 39501-2515 |
| Street Address |
1340 BROAD AVE SUITE 450 |
| City | GULFPORT |
| State | MS |
| Zip Code | 39501-2404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912904590 | Jesse Pullen Penico | Internal Medicine | 1340 Broad Ave, Suite 300, Gulfport, MS 39501-2404 | 2005-06-28 |
| 1306409040 | Lissa Kelly Baber | Nurse Practitioner | 1340 Broad Ave, Gulfport, MS 39501-2404 | 2019-04-18 |
| 1780191577 | Tbd Acquisition II LLC | Social Worker | 1340 Broad Ave, Gulfport, MS 39501-2404 | 2018-01-03 |
| 1629517115 | Delana Mooney | Nurse Practitioner | 1340 Broad Ave, Suite 450, Gulfport, MS 39501-2404 | 2017-02-16 |
| 1396299590 | Charles Strange | Nurse Practitioner | 1340 Broad Ave, Suite 450, Gulfport, MS 39501-2404 | 2016-08-05 |
| 1942699988 | Beth Ann Gruzinskas | Nurse Practitioner | 1340 Broad Ave, Suite 270, Gulfport, MS 39501-2404 | 2015-01-14 |
| 1720477714 | Lacey Grimes Lichtenstein | Nurse Practitioner | 1340 Broad Ave, Gulfport, MS 39501-2404 | 2015-01-14 |
| 1669872974 | Jamie B Varnado | Social Worker | 1340 Broad Ave, Ste 410, Gulfport, MS 39501-2404 | 2014-08-25 |
| 1700121209 | Danielle Ronquille Lipski | Occupational Therapist | 1340 Broad Ave, Suite 270, Gulfport, MS 39501-2404 | 2012-12-10 |
| 1164767778 | Shannon Ann Church | Social Worker | 1340 Broad Ave, Ste 410, Gulfport, MS 39501-2404 | 2012-12-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301632 | Daniel Edward Bloom | Physician Assistant | Naval Branch Health Clinic Gulfport, 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2019-11-25 |
| 1730721374 | Affinity Healthcare LLC | Non-emergency Medical Transport (VAN) | 1822 15th St, Suite 8, Gulfport, MS 39501 | 2019-10-15 |
| 1093361156 | Gulf Coast Companion Care, LLC | Home Health | 1314 Pass Road, Ste B, Gulfport, MS 39501 | 2019-08-14 |
| 1609420991 | Greg Meekin Ent | Otolaryngology | 1201 31st Avenue, Gulfport, MS 39501 | 2019-07-25 |
| 1225681216 | Murphy Chiropractic Gulfport, LLC | Clinic/Center | 2700 25th Ave., Gulfport, MS 39501 | 2019-07-19 |
| 1477022838 | Patriot Healthcare of Mississippi, LLC | Family Medicine | 1110 Broad Street, Suite 300, Gulfport, MS 39501 | 2018-11-15 |
| 1477003028 | Mindful Matters | Nurse Practitioner | 1613 23rd Avenue, Gulfport, MS 39501 | 2016-10-06 |
| 1902294093 | Tangular Barnes | Nurse Practitioner | Gulf Coast Mental Health Center, 1600 Broad Ave, Gulfport, MS 39501 | 2014-12-25 |
| 1487065355 | Huong Nguyen | Pharmacist | 2433 25th Avenue, Gulfport, MS 39501 | 2014-05-14 |
| 1770907412 | Matthew Coleman | Military Health Care Provider | Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-02-18 |
| Find all providers in zip 39501 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093901902 | William Lewis Seidensticker | Orthopaedic Surgery | 2 Bayou Pl, Gulfport, MS 39503-6231 | 2007-09-25 |
| 1306872171 | Eric Jude Letonoff | Orthopaedic Surgery | 452 Courthouse Rd Ste G, Gulfport, MS 39507-1800 | 2006-06-24 |
| 1689673071 | James C Thriffiley Iv | Orthopaedic Surgery | 1639 E Pass Rd, Gulfport, MS 39507 | 2005-07-18 |
| 1093710089 | Timothy D Jackson | Orthopaedic Surgery | 12080 New Orleans Ave N, Gulfport, MS 39503-3180 | 2005-06-16 |
| 1003254525 | Philip D Myers | Orthopaedic Surgery | 15190 Community Rd, Gulfport, MS 39503 | 2013-06-06 |
| 1609163682 | Joseph Tyler Cox | Orthopaedic Surgery | 15476 Dedeaux Rd, Gulfport, MS 39503 | 2011-06-29 |
| 1750558375 | Memorial Hospital At Gulfport | Orthopaedic Surgery | 1340 Broad Ave, Suite 450 O, Gulfport, MS 39501-2404 | 2008-05-13 |
| 1760531982 | Ronald Arly Graham | Orthopaedic Surgery | 15190 Community Rd, #360, Gulfport, MS 39503-2008 | 2007-01-09 |
| 1588725519 | Inez M Kelleher | Orthopaedic Surgery | 1340 Broad Ave, Ste 450, Gulfport, MS 39503 | 2006-12-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619526852 | Msk Group, PC | Orthopaedic Surgery | 7900 Airways Blvd Bldg B102, Southaven, MS 38671-4118 | 2019-09-10 |
| 1790193050 | Och Orthopedic Center | Orthopaedic Surgery | 401 Hospital Rd, Starkville, MS 39759-2164 | 2014-07-30 |
| 1679909774 | Irvin L. Martin IIi Md Pllc | Orthopaedic Surgery | 1800 12th St Ste 1e, Meridian, MS 39301-4158 | 2013-09-20 |
| 1073946216 | Madison Physician Surgery Center, LLC | Orthopaedic Surgery | 4510 Lakeland Dr, Flowood, MS 39232-9583 | 2013-08-12 |
| 1386076743 | William Ladwick Hand | Orthopaedic Surgery | 304 Kings Common, Ridgeland, MS 39157 | 2013-08-07 |
| 1184068413 | Thomas Payne Royals | Orthopaedic Surgery | 103 Tatum Rd, Hattiesburg, MS 39401-5186 | 2013-04-17 |
| 1639426117 | Southern Bone & Joint Specialists, Pa | Orthopaedic Surgery | 7127 Highway 98, Suite 20, Hattiesburg, MS 39402 | 2012-08-14 |
| 1487901807 | Southern Bone & Joint Specialists, Pa | Orthopaedic Surgery | 1215 Highway 98 Byp, Columbia, MS 39429-3702 | 2012-08-06 |
| 1477817799 | Matthew A Miller | Orthopaedic Surgery | 1211 South Gloster St, Suite A, Tupelo, MS 38801 | 2012-07-02 |
| 1831453158 | Phillip Anthony Sandifer | Orthopaedic Surgery | 100 Baptist Memorial Cir Ste 330, Oxford, MS 38655-4477 | 2012-07-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.