DIBERVILLE MEDICAL SPA (NPI# 1861766289) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861766289 |
| Entity Type | Organization |
| Organization Name | DIBERVILLE MEDICAL SPA |
| Practice Address |
3661 Sangani Blvd Suite C Diberville MS 39540-8706 |
| Mailing Address |
Po Box 1248 Ocean Springs MS 39566-1248 |
| Practice Telephone | 2282231927 |
| Mailing Telephone | 2282231927 |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2012-03-02 |
| Authorized Official Name | RONNIE ALI (PRESIDENT) |
| Authorized Official Telephone | 2282231927 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Street Address |
3661 SANGANI BLVD SUITE C |
| City | DIBERVILLE |
| State | MS |
| Zip Code | 39540-8706 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194330597 | Milton Eduardo Torres Caban | Dentist | 3661 Sangani Blvd, Diberville, MS 39540-8706 | 2020-09-11 |
| 1588790497 | Donna Marie Boyd | Nurse Practitioner | 3661 Sangani Blvd, Suite E, Diberville, MS 39540-8706 | 2007-02-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528347531 | Lindsey Rachelle Cuevas | Pharmacist | 10551 D'iberville Blvd, D'iberville, MS 39540 | 2011-08-08 |
| 1750438255 | Andrea L Davis | Dentist | 11505 Cinema Drive, Suite 6, D'iberville, MS 39540 | 2007-01-05 |
| 1568948016 | Courtney Leigh Ponder | Nurse Practitioner | 11516 Lamey Bridge Rd Ste I, Diberville, MS 39540 | 2018-07-18 |
| 1134635360 | Southern Regional Chiropractic and Rehabilitation Center | Nurse Practitioner | 11505 Cinema Dr Ste 7, Diberville, MS 39540 | 2017-12-26 |
| 1487177481 | Walgreen Co | Pharmacy | 4031 Popps Ferry Rd Ste A, Diberville, MS 39540 | 2017-07-21 |
| 1891151817 | Total Renal Care Inc | Clinic/Center | 3200 Mallett Rd, Ste F, Diberville, MS 39540 | 2016-01-06 |
| 1679944763 | Katelyn Elizabeth Martin | Behavioral Analyst | 4061 Suzanne Dr, Diberville, MS 39540 | 2015-10-14 |
| 1467880922 | Carla Diane Diffenderfer | Nurse Practitioner | 11516 Lamey Bridge Rd Ste I, Diberville, MS 39540 | 2013-10-21 |
| 1982618369 | Becky F Hollibaugh | Family Medicine | 3920 Promenade Pkwy, Biloxi, MS 39540 | 2006-07-28 |
| 1962029629 | Jessica Jensen | Counselor | 356 Ginger Dr. #7385, D'iberville, MS 39540-0003 | 2020-06-29 |
| Find all providers in zip 39540 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760080337 | Traditions Hospice of Biloxi, LLC | Clinic/Center | 243 Beauvoir Rd Ste B, Biloxi, MS 39531-4008 | 2020-10-15 |
| 1386242097 | Traditions Hospice of Ridgeland, LLC | Clinic/Center | 680 Highway 51 Ste L, Ridgeland, MS 39157-2103 | 2020-10-14 |
| 1346848694 | Hayco LLC | Clinic/Center | 425 S Jackson St, Brookhaven, MS 39601-3817 | 2020-10-09 |
| 1023620135 | Neshoba County General Hospital-nursing Home | Clinic/Center | 406 Stribling St, Philadelphia, MS 39350-3344 | 2020-08-19 |
| 1023628245 | Durrett Health Care LLC | Clinic/Center | 1515 Munsford Dr, New Albany, MS 38652-7407 | 2020-08-03 |
| 1124644968 | First Choice Family Medical Clinic, LLC | Clinic/Center | 50 Highway 388, Brooksville, MS 39739 | 2020-06-17 |
| 1104447507 | Grace & Mercy Healthcare Center | Clinic/Center | 131 Lexington St, Pickens, MS 39146-3914 | 2020-04-27 |
| 1437788908 | Wellness Center | Clinic/Center | 1727 6th St, Meridian, MS 39301-5249 | 2020-04-06 |
| 1669018008 | Maximum Care After Hours Clinic, LLC | Clinic/Center | 212 Highway 61, Shaw, MS 38773-3877 | 2019-11-20 |
| 1598316895 | Florence Health Complex, LLC | Clinic/Center | 130 S Church St, Florence, MS 39073-8478 | 2019-09-27 |
| Find all providers with the same taxonomy | ||||
| City | DIBERVILLE |
| Zip Code | 39540 |
Please comment or provide details below to improve the information on DIBERVILLE MEDICAL SPA.
| 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.