HATTIESBURG CLINIC PA (NPI# 1508948910) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508948910 |
| Entity Type | Organization |
| Organization Name | HATTIESBURG CLINIC PA |
| Other Organization Name | CARDIOVASCULAR SURGERY |
| Practice Address |
415 S 28th Ave Hattiesburg MS 39401-7246 |
| Practice Telephone | 6012685800 |
| Practice Fax Number | 6012613530 |
| Mailing Telephone | 6012685800 |
| Mailing Fax Number | 6012613530 |
| Enumeration Date | 2006-10-19 |
| 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 | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 04886578 | 05 |
| Other Name | Type Code |
|---|---|
| Cardiovascular Surgery | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831251925 | Hattiesburg Clinic Pa | Clinic/Center | 101 Courtenay Cir, Hattiesburg, MS 39402-3153 | 2006-12-14 |
| 1649332735 | Hattiesburg Clinic Pa | Psychologist | 2 Southern Point Pkwy Ste 201, Hattiesburg, MS 39401-8025 | 2006-12-14 |
| 1033270921 | Hattiesburg Clinic Pa | Internal Medicine | 940 Matthew Dr, Waynesboro, MS 39367-2522 | 2006-12-13 |
| 1184785065 | Hattiesburg Clinic Pa | Ophthalmology | 6414 Highway 98 West, Suite 80, Hattiesburg, MS 39402 | 2006-12-13 |
| 1417046574 | Hattiesburg Clinic Pa | Family Medicine | 2013 North Pine, Heidelberg, MS 39439 | 2006-10-12 |
| 1962599282 | Hattiesburg Clinic Pa | Physical Therapist | 206 Corinth Rd, Petal, MS 39465-2883 | 2006-10-06 |
| 1972690287 | Hattiesburg Clinic Pa | Ophthalmology | 321 S 11th Ave, Laurel, MS 39440-4316 | 2006-10-06 |
| 1114014479 | Hattiesburg Clinic Pa | Dermatology | 6 Medical Blvd, Hattiesburg, MS 39401-7230 | 2006-10-06 |
| 1104910322 | Hattiesburg Clinic Pa | Family Medicine | 300 Pine St, Taylorsville, MS 39168-5432 | 2006-10-03 |
| 1730272931 | Hattiesburg Clinic Pa | Family Medicine | 801 Main Ave S, Magee, MS 39111-4102 | 2006-10-02 |
| Street Address |
415 S 28TH AVE |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39401-7246 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225030372 | Norman Blake Moore Jr. | Nurse Anesthetist, Certified Registered | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2005-06-01 |
| 1457950842 | Tyler Griffin Armstrong | Nurse Anesthetist, Certified Registered | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2020-10-19 |
| 1538776679 | Hattiesburg Clinic, Pa | Clinic/Center | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2020-09-23 |
| 1205446804 | Robert Price Ledbetter | Perfusionist | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2020-08-07 |
| 1972143626 | Jarrod Edward Gant | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7283 | 2020-01-10 |
| 1720625841 | Corey Lyle Gambrell | Nurse Anesthetist, Certified Registered | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2019-12-09 |
| 1447802103 | Heather Pritchett Bassi | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2019-07-12 |
| 1891357588 | Dylan Winston Boyd | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2019-07-02 |
| 1578124186 | Casie Barnes | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2019-06-25 |
| 1992364491 | Stacy Louise Neames | Nurse Practitioner | 415 S 28th Ave, Hattiesburg, MS 39401-7283 | 2019-06-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598315863 | Lisa Thornton | Technician | 18 Timberline Dr., Hattiesburg, MS 39401 | 2019-09-18 |
| 1548813637 | Caroline Estes Barnes | Counselor | Barnes, 8 App Slade Road, Hattiesburg, MS 39401 | 2019-07-18 |
| 1396252441 | Selection Healthcare Services, LLC | In Home Supportive Care | 606 Adeline St Ste 1c, Hattiesburg, MS 39401 | 2018-01-10 |
| 1225545585 | Whitney Wilkinson | Nurse Practitioner | 301 South 28th Avenue, Hattiesburg, MS 39401 | 2018-01-08 |
| 1740795806 | Forrest General Hospital | Pharmacy | 1414 South 28th Avenue, Hattiesburg, MS 39401 | 2017-12-11 |
| 1275058455 | Casey Payne | Pharmacist | 6130 Us 49, Hattiesburg, MS 39401 | 2017-08-08 |
| 1225562705 | Sarah Marie Hudson | Family Medicine | 6051 Us Highway 49 S, Hattiesburg, MS 39401 | 2017-04-12 |
| 1043671704 | The Covington's Cove Assisted Living Center LLC | Assisted Living Facility | 192 Mary Magdalene Church Rd, Hattiesburg, MS 39401 | 2016-03-09 |
| 1780083626 | Dominique Reed Watson | Pharmacist | 602 Adeline St, Hattiesburg, MS 39401 | 2014-08-15 |
| 1558778936 | Willie Davis Jr. | Day Training, Developmentally Disabled Services | 701 Duke Ave., Hattiesbiurg, MS 39401 | 2014-07-17 |
| Find all providers in zip 39401 | ||||
| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003020561 | Scott Eric Henry | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5003 Hardy St Ste 200, Hattiesburg, MS 39402-1331 | 2007-05-10 |
| 1265521710 | Fidel Fabian Sendra | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5003 Hardy St Ste 200, Hattiesburg, MS 39402-1331 | 2006-10-12 |
| 1780792945 | Robert J Robbins | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-08-28 |
| 1427163724 | Lacy C Mcclain | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-08-20 |
| 1144334814 | James B Kot | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2006-08-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588939581 | William Lawson Safley | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 11078 Channelside Dr, Gulfport, MS 39503-6049 | 2012-03-09 |
| 1932400769 | Stewart Allen Nutting | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 6716 Alewa Pl, Diamondhead, MS 39525-3429 | 2010-11-10 |
| 1922285378 | Coast Cardiothoracic Surgery, Pllc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1308 44th Ave, Gulfport, MS 39501-2552 | 2008-01-29 |
| 1407072747 | Robert P. N. Shearin | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 308 Hillchase Dr, Madison, MS 39110-8841 | 2007-04-17 |
| 1467571430 | Delta Physician Practices | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1202 Hospital St, Greenville, MS 38703-3213 | 2007-03-28 |
| 1841387727 | David Bruce Allen | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4300 Hospital Rd, Suite 105, Pascagoula, MS 39581 | 2006-10-10 |
| 1114021722 | Robert G Johnson | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3603 Bienville Blvd, Suite 103, Ocean Springs, MS 39564-5727 | 2006-09-12 |
| 1114036290 | David A Geer | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1400 20th Ave, Suite F, Meridian, MS 39301-4111 | 2006-08-30 |
| 1477560050 | James C Gilmore | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 611 Alcorn Dr Ste 200, Corinth, MS 38834-9323 | 2006-08-03 |
| 1740203199 | Hazem Barmada | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1155 Ocean Springs Rd, Ocean Springs, MS 39564-3421 | 2006-07-26 |
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| City | HATTIESBURG |
| Zip Code | 39401 |
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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.