SOUTH MISSISSIPPI MAXILLOFACIAL SURGERY CENTER (NPI# 1902858004) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902858004 |
| Entity Type | Organization |
| Organization Name | SOUTH MISSISSIPPI MAXILLOFACIAL SURGERY CENTER |
| Practice Address |
1760 Medical Park Dr Suite B Biloxi MS 39532-2131 |
| Practice Telephone | 2283885925 |
| Practice Fax Number | 2283888153 |
| Mailing Telephone | 2283885925 |
| Mailing Fax Number | 2283888153 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. ROBERT T WATTS, JR (ORAL PHYSICIAN/MEDICAL DIRECTOR) |
| Authorized Official Telephone | 2283885925 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
MS | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 1987800 | 05 |
| Street Address |
1760 MEDICAL PARK DR SUITE B |
| City | BILOXI |
| State | MS |
| Zip Code | 39532-2131 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386691343 | Gulf Coast Oral & Facial Surgery, P.a. | Dentist | 1760 Medical Park Dr, Suite A, Biloxi, MS 39532-2131 | 2006-05-27 |
| 1245285592 | John H Watts | Dentist | 1760 Medical Park Dr, Sutie A, Biloxi, MS 39532-2131 | 2006-05-24 |
| 1821041492 | Thomas Zakkak | Dentist | 1760 Medical Park Dr, Suite A, Biloxi, MS 39532-2131 | 2006-05-18 |
| 1407809098 | Robert T Watts, Jr | Dentist | 1760 Medical Park Dr, Suite A, Biloxi, MS 39532-2131 | 2006-05-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427693613 | Bloom Mental Health LLC | Nurse Practitioner | 933 Tommy Munro Dr., Suite C, Biloxi, MS 39532 | 2019-11-12 |
| 1003397530 | The National Diabetes & Obesity Research Institute At Tradition, Missi | Dietitian, Registered | 19289 St. Joseph Street, Suite C, Biloxi, MS 39532 | 2018-08-23 |
| 1134588999 | Victoria Leonard Scott | Counselor | 6905 Gregory Dr, Biloxi, MS 39532 | 2016-02-22 |
| 1639552490 | Laura O'keefe | Nurse Practitioner | 1720a Medical Park Dr Ste 150, Biloxi, MS 39532 | 2015-06-29 |
| 1659767150 | D'iberville Home Program LLC | Clinic/Center | 14215 Cook Road, Biloxi, MS 39532 | 2015-04-10 |
| 1467842476 | Alicia Michelle Mcdaniel | Nurse Practitioner | 14209 Cook Rd Suite 200, Biloxi, MS 39532 | 2015-01-28 |
| 1437402393 | Lisa Q. Brown | Occupational Therapist | 680 Bay Cove Drive, Residents At Baycove, Biloxi, MS 39532 | 2012-10-17 |
| 1962759381 | Joshua Shumway | Physical Therapist | 220 Ploesti Dr, Keesler Afb, MS 39532 | 2012-08-06 |
| 1386912483 | Polk's Crossgates Discount Drugs Inc. | Pharmacy | 1845 Popps Ferry Road, Biloxi, MS 39532 | 2011-12-05 |
| 1346566957 | Kerri Lyn Manjarrez | Social Worker | 12304 Tiffany Lane, Biloxi, MS 39532 | 2010-04-08 |
| Find all providers in zip 39532 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093121196 | Gulf Coast Outpatient Surgery Center, LLC | Clinic/Center | 2781 Ct Senior Switzer Drive, Suite 101, Biloxi, MS 39531 | 2014-07-09 |
| 1295820249 | New Cedar Lake Surgery Center, LLC | Clinic/Center | 1720 Medical Park Dr # B, Biloxi, MS 39532-2131 | 2006-10-04 |
| 1740385632 | Gulf Coast Outpatient Surgery Center LLC | Clinic/Center | 2781 C.t. Switzer Sr Dirve, Suite 101, Biloxi, MS 39531-4535 | 2006-09-14 |
| 1568722353 | Larry Hammonds | Clinic/Center | 1720b Medical Park Dr, Biloxi, MS 39532-2131 | 2012-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497391619 | Madison Spine Surgery Center, LLC | Clinic/Center | 160 Fountains Blvd Ste C, Madison, MS 39110-6380 | 2019-11-22 |
| 1588224802 | Flowood Surgery Center LLC | Clinic/Center | 120 Stone Creek Blvd Ste 400, Flowood, MS 39232-8210 | 2019-06-18 |
| 1912480070 | Sog Surgery Center LLC | Clinic/Center | 1211 S Gloster St Ste B, Tupelo, MS 38801-6535 | 2018-09-13 |
| 1942793823 | Starkville Surgery Center LLC | Clinic/Center | 110 Walker Way, Starkville, MS 39759-6607 | 2018-06-14 |
| 1194214510 | Specialty Surgery & Laser Center | Clinic/Center | 306 Bradley Rd Ste A, Corinth, MS 38834-7047 | 2018-05-02 |
| 1154867562 | Urologic Ambulatory Surgery Center, LLC | Clinic/Center | 3353 N Gloster Street, Suite 300, Tupelo, MS 38804 | 2017-01-09 |
| 1205218690 | Nurse Practitioner Professionals, Pllc | Clinic/Center | 427 Highway 51 Se, Kings Daughters Medical Center-wound Healing Center, Brookhaven, MS 39601 | 2015-06-23 |
| 1487094058 | Comprehensive Pain Center for Surgery | Clinic/Center | 129 Fountains Blvd., Madison, MS 39110 | 2013-06-27 |
| 1821336371 | Eyecare Surgery Center, LLC | Clinic/Center | 1501 Lakeland Dr Ste 101, Jackson, MS 39216-4839 | 2013-01-17 |
| 1518246081 | The Surgery Center LLC | Clinic/Center | 2466 Flowood Dr Ste A, Flowood, MS 39232 | 2011-08-15 |
| Find all providers with the same taxonomy | ||||
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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.