MEMORIAL HOSPITAL OF GULFPORT (NPI# 1669619912) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669619912 |
| Entity Type | Organization |
| Organization Name | MEMORIAL HOSPITAL OF GULFPORT |
| Other Organization Name | PHYSICIANS CLINIC AT MHG |
| Practice Address |
1340 Broad Ave Ste 210 Gulfport MS 39501-2404 |
| Mailing Address |
Po Box 555 Biloxi MS 39533-0555 |
| Practice Telephone | 2285751600 |
| Practice Fax Number | 2285751603 |
| Mailing Telephone | 2288651453 |
| Mailing Fax Number | 2288651457 |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2011-01-03 |
| Authorized Official Name | MR. JEFF T STEINER (VP OF FINANCE) |
| Authorized Official Telephone | 2288653106 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 06471328 | 05 |
| Other Name | Type Code |
|---|---|
| Physicians Clinic at MHG | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790818532 | Memorial Hospital of Gulfport | Pharmacy | 4500 13th St, Gulfport, MS 39501-2515 | 2007-03-13 |
| Street Address |
1340 BROAD AVE STE 210 |
| 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 | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023678000 | The Urology Clinic, LLC | Urology | 14231 Seaway Rd Ste 6000, Gulfport, MS 39503-4628 | 2019-06-20 |
| 1407969207 | Memorial Hospital At Gulfport | Urology | 1340 Broad Ave Ste 210, Gulfport, MS 39501-2465 | 2006-08-16 |
| 1093031494 | Memorial Hospital At Gulfport | Urology | 15190 Community Rd, Suite 240, Gulfport, MS 39503-3485 | 2010-04-12 |
| 1871737064 | Jacob N Jorns | Urology | 1340 Broad Ave Ste 210, Gulfport, MS 39501-2465 | 2009-05-01 |
| 1962690255 | Memorial Hospital At Gulfport | Urology | 1340 Broad Ave, Suite 210, Gulfport, MS 39501-2404 | 2007-10-11 |
| 1962557157 | Southern Urology Associates LLC | Urology | 12330 Ashley Dr, Gulfport, MS 39503-2737 | 2007-01-25 |
| 1194825216 | Paige C White | Urology | 1340 Broad Ave, Suite 210, Gulfport, MS 39501-2404 | 2006-09-25 |
| 1548285968 | David Champ Weeks | Urology | 1340 Broad Ave, Suite 210, Gulfport, MS 39501-2404 | 2006-07-13 |
| 1760417612 | Arthur M Matthews Jr. | Urology | 15190 Community Rd, Suite 370, Gulfport, MS 39503-3485 | 2006-07-11 |
| 1619919917 | Southern Urology Associates LLC | Urology | 15190 Community Rd, Suite 260, Gulfport, MS 39503-3485 | 2006-06-12 |
| Find all providers in GULFPORT | ||||
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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.