HATTIESBURG CLINIC, PA (NPI# 1821021155) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821021155 |
| Entity Type | Organization |
| Organization Name | HATTIESBURG CLINIC, PA |
| Other Organization Name | TYLERTOWN DIALYSIS UNIT |
| Practice Address |
4820 Plaza Dr Tylertown MS 39667-9221 |
| Mailing Address |
415 S 28th Ave Hattiesburg MS 39401-7246 |
| Practice Telephone | 6012220311 |
| Practice Fax Number | 6012220351 |
| Mailing Telephone | 6012220311 |
| Mailing Fax Number | 6012220351 |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2014-08-27 |
| Authorized Official Name | TOMMY G THORNTON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6012685601 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | UNITED HEALTHCARE | 5000477 | 01 |
| MS | BLUE CROSS BLUE SHIELD MS | 000050656 | 01 |
| MS | 00220570 | 05 |
| Other Name | Type Code |
|---|---|
| Tylertown Dialysis Unit | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295392074 | Hattiesburg Clinic, Pa | Preventive Medicine | 6414 Highway 98, Suite 120, Hattiesburg, MS 39402 | 2019-05-28 |
| 1679053979 | Hattiesburg Clinic, Pa | Family Medicine | South 28th Avenue Family Medicine, 1101 South 28th Avenue, Suite C, Hattiesburg, MS 39402 | 2018-08-16 |
| 1750882080 | Hattiesburg Clinic, Pa | Physical Medicine & Rehabilitation | 2 Southern Point Pkwy Ste 200, Hattiesburg, MS 39401-8025 | 2018-02-22 |
| 1801310768 | Hattiesburg Clinic, Pa | Clinic/Center | 5909 Hwy 49 S, Suite 14, Hattiesburg, MS 39402-2860 | 2017-08-01 |
| 1346780681 | Hattiesburg Clinic, Pa | Family Medicine | 202 E Main Ave, Lumberton, MS 39455-2608 | 2017-03-06 |
| 1356781082 | Hattiesburg Clinic, Pa | Family Medicine | 6941 Highway 11 N, Suite A, Carriere, MS 39426-7793 | 2013-06-26 |
| 1689830549 | Hattiesburg Clinic, Pa | Physical Therapist | 1403 S Main St Ste E, Poplarville, MS 39470-3394 | 2008-07-31 |
| 1841494895 | Hattiesburg Clinic, Pa | Clinic/Center | 103 Asbury Cir, Hattiesburg, MS 39402-1302 | 2007-06-13 |
| 1669405981 | Hattiesburg Clinic, Pa | Clinic/Center | 14 Bay Ave, Bay Springs, MS 39422-9206 | 2006-07-09 |
| 1245263540 | Hattiesburg Clinic, Pa | Clinic/Center | 1527 Larry Dr, Laurel, MS 39440-1932 | 2006-07-09 |
| Street Address |
4820 PLAZA DR |
| City | TYLERTOWN |
| State | MS |
| Zip Code | 39667-9221 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891212221 | Lavarshia Newsome-pittman | Pharmacist | 3000 Plaza Drive, Tylertown, MS 39667 | 2017-08-25 |
| 1891171039 | Tanya Marie Holmes-morris | Home Health Aide | 42 West Mt. Olive Rd, Tylertown, MS 39667 | 2015-08-10 |
| 1376776930 | Family Health Care Clinic, Inc. | Clinic/Center | 225 Saint Paul Road, Tylertown, MS 39667 | 2009-08-31 |
| 1427221290 | Family Health Care Clinic, Inc. | Clinic/Center | 113 Enoch St, Tylertown, MS 39667 | 2008-04-11 |
| 1275651879 | John C Barrett | Dentist | 75 Old Hwy 98 E, Tylertown, MS 39667 | 2007-03-26 |
| 1497895551 | L & L Hospice, Inc. | Hospice Care, Community Based | 423 A Beulah, Tylertown, MS 39667 | 2007-02-07 |
| 1114009610 | Ruthie L Lewis | Licensed Practical Nurse | 423a Beulah Avenue, Tylertown, MS 39667 | 2006-10-20 |
| 1245512417 | Walthall General Hospital | Internal Medicine | 100 Hospital Drive, Tylertown, MS 39667 | 2011-09-14 |
| 1255649604 | Walthall General Hospital | General Acute Care Hospital | 200 Hospital Dr, Tylertown, MS 39667 | 2010-09-20 |
| 1407499296 | Belinda May Ratcliff | Pharmacist | 201 Hospital Dr, Tylertown, MS 39667-2019 | 2019-10-23 |
| Find all providers in zip 39667 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760092878 | Bio-medical Applications of Mississippi, Inc. | Clinic/Center | 5722 I-55 N Frontage Road, Jackson, MS 39211 | 2020-08-04 |
| 1952910457 | Fresenius Medical Care East Mccomb Dialysis, LLC | Clinic/Center | 103 Business Center Drive, Mccomb, MS 39648 | 2020-07-30 |
| 1013535780 | Fresenius Medical Care Meridian Home, LLC | Clinic/Center | 2400 15th St, Meridian, MS 39301-3951 | 2020-07-09 |
| 1922631837 | Fresenius Medical Care Dogwood, LLC | Clinic/Center | 205b Belle Meade Pt, Flowood, MS 39232-3311 | 2020-02-19 |
| 1669944120 | Fresenius Medical Care Adams County Home, LLC | Clinic/Center | 151 Jefferson Davis Blvd Ste D, Natchez, MS 39120-5140 | 2018-12-21 |
| 1205334513 | Renal Care Group Tupelo, LLC | Clinic/Center | 1031 S Madison St, Tupelo, MS 38801-6309 | 2018-02-01 |
| 1801310768 | Hattiesburg Clinic, Pa | Clinic/Center | 5909 Hwy 49 S, Suite 14, Hattiesburg, MS 39402-2860 | 2017-08-01 |
| 1184146789 | Lakeland Home Program LLC | Clinic/Center | 209 Mar Lyn Dr, Brandon, MS 39042 | 2017-07-14 |
| 1932636495 | Rcg Mississippi, Inc. | Clinic/Center | 1300 38th Ave E, Meridian, MS 39301 | 2017-05-16 |
| 1710411707 | Rcg Mississippi, Inc. | Clinic/Center | 1100 Central Drive, Philadelphia, MS 39350 | 2017-04-17 |
| Find all providers with the same taxonomy | ||||
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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.