SPINE MEDICAL CENTER OF HATTIESBURG (NPI# 1982824579) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982824579 |
| Entity Type | Organization |
| Organization Name | SPINE MEDICAL CENTER OF HATTIESBURG |
| Practice Address |
1 Lincoln Pkwy Suite 104 Hattiesburg MS 39402-3262 |
| Mailing Address |
Po Box 2156 Gulfport MS 39505-2156 |
| Practice Telephone | 6012649448 |
| Practice Fax Number | 6012649449 |
| Mailing Telephone | 2288654731 |
| Mailing Fax Number | 2288635616 |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2008-07-02 |
| Authorized Official Name | DR. DAVIDE CLARK LEE (DR.) |
| Authorized Official Telephone | 6012649448 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207T00000X | Neurological Surgery | 14446 | MS | Allopathic & Osteopathic Physicians |
| Street Address |
1 LINCOLN PKWY SUITE 104 |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39402-3262 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669486692 | Brent D Bevard | Physical Medicine & Rehabilitation | 1 Lincoln Pkwy, Suite 103, Hattiesburg, MS 39402-3262 | 2006-07-27 |
| 1346691714 | Billy J Thornton | Nurse Practitioner | 1 Lincoln Pkwy, Suite 202, Hattiesburg, MS 39402-3262 | 2016-06-28 |
| 1568874808 | Lacey Loy Herrington | Student in an Organized Health Care Education/Training Program | 1 Lincoln Pkwy, Hattiesburg, MS 39402-3262 | 2014-05-21 |
| 1790104750 | Southern Laboratory Services, LLC | Clinical Medical Laboratory | 1 Lincoln Pkwy, Suite 101, Hattiesburg, MS 39402-3262 | 2014-04-07 |
| 1710302922 | Tamra Lynn Thomas | Nurse Practitioner | 1 Lincoln Pkwy, Suite 202, Hattiesburg, MS 39402-3262 | 2014-02-25 |
| 1629403480 | Forrest County General Hospital | Obstetrics & Gynecology | 1 Lincoln Pkwy, Suite 103, Hattiesburg, MS 39402-3262 | 2013-09-11 |
| 1356774772 | Christina I Williams | Psychologist | 1 Lincoln Pkwy, Suite 202, Hattiesburg, MS 39402-3262 | 2013-08-21 |
| 1447682729 | Steffany Bedwell | Nurse Practitioner | 1 Lincoln Pkwy, Suite 103, Hattiesburg, MS 39402-3262 | 2013-08-08 |
| 1689016065 | Philip C Hemphill | Social Worker | 1 Lincoln Pkwy, Suite 204, Hattiesburg, MS 39402-3262 | 2013-07-25 |
| 1023350006 | Lincoln Center Clinic | Family Medicine | 1 Lincoln Pkwy, Suite 302, Hattiesburg, MS 39402-3262 | 2013-03-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518572965 | Resilient Therapy and Solutions, Pllc | Clinic/Center | 5266 Old Hwy 11 Ste 50, #308, Hattiesburg, MS 39402 | 2020-09-12 |
| 1932710225 | Jones County Medical Supplies, Inc | Durable Medical Equipment & Medical Supplies | 6424 Hwy 98 West, Suite 20, Hattiesburg, MS 39402 | 2020-08-11 |
| 1467086736 | Elizabeth A. Perry | Technician | 1220 Marrie St, Hattiesburg, MS 39402 | 2020-02-26 |
| 1225678063 | Connor Gregory Galloway | Physical Therapist | 3688 Veteran Memorial Drive, Hattiesburg, MS 39402 | 2020-01-09 |
| 1487291456 | Megan Marie Smith | Social Worker | 11 Woodstone Plaza, Hattiesburg, MS 39402 | 2019-12-09 |
| 1821656612 | Julie Covington Mcmahan | Dentist | 100 Madison Plaza, Hattiesburg, MS 39402 | 2019-06-05 |
| 1295392074 | Hattiesburg Clinic, Pa | Preventive Medicine | 6414 Highway 98, Suite 120, Hattiesburg, MS 39402 | 2019-05-28 |
| 1760945356 | Rachandeep Chahal | Student in an Organized Health Care Education/Training Program | 5001 Hardy Street Merit Health Wesley, Hattiesburg, MS 39402 | 2019-04-10 |
| 1386101137 | Courtney L Smith | Behavior Technician | 32 Millbanch Road, Suite 40, Hattiesburg, MS 39402 | 2019-02-28 |
| 1891269940 | Amanda Laine Mcarthur-macisaac | Registered Nurse | 5909 Highway 49 South, Suite 30, Hattiesburg, MS 39402 | 2019-01-11 |
| Find all providers in zip 39402 | ||||
| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497872212 | Timothy M. Wiebe | Neurological Surgery | 103 Aldersgate Cir, Hattiesburg, MS 39402-1301 | 2007-03-25 |
| 1700844875 | Kerry L Bernardo | Neurological Surgery | 3688 Veterans Memorial Drive, Suite 200, Hattiesburg, MS 39401 | 2006-05-01 |
| 1104366087 | South Mississippi Neurosurgical Services, Pllc | Neurological Surgery | 1212 South 28th Ave, Hattiesburg, MS 39402 | 2017-02-27 |
| 1104002047 | Gregory R Toczyl | Neurological Surgery | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2008-01-10 |
| 1902095664 | Daryl Aundra Johnson | Neurological Surgery | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2007-10-18 |
| 1003030578 | Frank Joseph Hux | Neurological Surgery | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2007-04-13 |
| 1386764132 | Bradley T Hall | Neurological Surgery | 415 S 28th Ave, Hattiesburg, MS 39401 | 2007-03-29 |
| 1710057377 | Michael W Lowry | Neurological Surgery | 200 Hospital Dr W, Hattiesburg, MS 39402-1346 | 2006-11-09 |
| 1972692820 | Hattiesburg Clinic Pa | Neurological Surgery | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-10-11 |
| 1073612651 | Neurosurgery of Hattiesburg, Pa | Neurological Surgery | 5003 Hardy St, Ste 401, Hattiesburg, MS 39402-1319 | 2006-09-21 |
| Find all providers in HATTIESBURG | ||||
| City | HATTIESBURG |
| Zip Code | 39402 |
Please comment or provide details below to improve the information on SPINE MEDICAL CENTER OF HATTIESBURG.
| 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.