GARDEN PARK PHYSICIAN SERVICES CORP (NPI# 1871523423) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871523423 |
| Entity Type | Organization |
| Organization Name | GARDEN PARK PHYSICIAN SERVICES CORP |
| Other Organization Name | FAMILY MEDICAL CENTER OF ORANGE GROVE |
| Practice Address |
12330 Ashley Dr Gulfport MS 39503-2737 |
| Practice Telephone | 2288637117 |
| Practice Fax Number | 2288689388 |
| Mailing Telephone | 2288637117 |
| Mailing Fax Number | 2288689388 |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2007-10-10 |
| Authorized Official Name | ROBERT LAGESSE (VICE PRESIDENT) |
| Authorized Official Telephone | 5049887044 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09016019 | 05 |
| Other Name | Type Code |
|---|---|
| Family Medical Center of Orange Grove | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881882405 | Garden Park Physician Services Corp | Family Medicine | 1924 30th Ave, Gulfport, MS 39501-4534 | 2007-10-09 |
| Street Address |
12330 ASHLEY DR |
| City | GULFPORT |
| State | MS |
| Zip Code | 39503-2737 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447248661 | Curtis A Broussard | General Practice | 12330 Ashley Dr, Gulfport, MS 39503-2737 | 2005-10-11 |
| 1962557157 | Southern Urology Associates LLC | Urology | 12330 Ashley Dr, Gulfport, MS 39503-2737 | 2007-01-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013515451 | Gulf Coast Neurospa, LLC | Psychiatry & Neurology | 8845 Lorraine Road, Gulfport, MS 39503 | 2020-10-16 |
| 1447865985 | Nicholas Wyrosdick | Physical Therapist | 12261 Us 49 #1, Gulfport, MS 39503 | 2020-09-11 |
| 1750935169 | Ladner Roy Drugs, LLC. | Pharmacy | 12261 Us 49 Suite 16, Gulfport, MS 39503 | 2019-07-25 |
| 1528559440 | Alexander Therapy Services, LLC | Clinic/Center | 15465 Oak Ln Ste 100c, Gulfport, MS 39503 | 2018-05-25 |
| 1750879003 | Heather Lynn Theisen | Nurse Practitioner | 15190 Community Rd Ste 330, Gulfport, MS 39503 | 2018-04-23 |
| 1083101216 | Gulf Coast Mental Health Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15094 County Barn Road, Gulfport, MS 39503 | 2018-04-13 |
| 1306343173 | Dr. Raymond Monsour Scurfield, LLC | Community/Behavioral Health | 15465 Oak Lane Ste 100-g, Gulfport, MS 39503 | 2018-04-09 |
| 1952817157 | Mary Beth Welch | Behavioral Analyst | 9230 Old Lorraine Rd, Gulfport, MS 39503 | 2017-12-26 |
| 1831603257 | Beach View Family Dental, Pllc | Dentist | 9072 Lorraine Road, Gulfport, MS 39503 | 2017-11-21 |
| 1437677721 | Mary Stephens Ruffin | Social Worker | 11262 Creek Dr, Gulfport, MS 39503 | 2017-09-07 |
| Find all providers in zip 39503 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366993321 | D Balder Md Pllc | Specialist | 15190 Community Rd Ste 210, Gulfport, MS 39503-3483 | 2016-10-14 |
| 1619427374 | Anthony Jamaal Anderson | Specialist | 295 Debuys Rd, Gulfport, MS 39507-2800 | 2016-10-06 |
| 1720368905 | Gulfport Medical Weight Loss | Specialist | 12337 Ashley Dr, Suite F, Gulfport, MS 39503-2753 | 2011-08-19 |
| 1679879936 | Jennifer Boudreaux May | Specialist | 13418 Tara Hills Dr, Gulfport, MS 39503-2332 | 2011-02-04 |
| 1720284946 | The Dermatology Clinic, Pllc | Specialist | 11295 East Taylor Road, Gulfport, MS 39503 | 2007-06-25 |
| 1366560435 | Coastal Ear, Nose and Throat, Head and Neck Surgery Associates, Pllc | Specialist | 407 Security Sq, Gulfport, MS 39507-1922 | 2007-03-27 |
| 1790802247 | Gulfcoast Pulmonary Consultants Pa | Specialist | 15190 Community Rd Ste 220, Gulfport, MS 39503-3483 | 2007-03-22 |
| 1811084171 | Eric H Wolfson | Specialist | 1340 Broad Street, Suite 440, Gulfport, MS 39501 | 2006-10-06 |
| 1255424727 | Peter Joseph Bernheim | Specialist | 4500 West Railroad Street, Gulfport, MS 39503 | 2006-10-02 |
| 1174614325 | Spinal & Neurological Surgery of South Mississippi Pllc | Specialist | 15190 Community Road, Suite 300, Gulfport, MS 39503-3499 | 2006-09-27 |
| 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.