ENDOCRINE & METABOLIC DISORDERS INSTITUTE PLLC - NPI NUMBER 1457322661

Summary

Provider Name: ENDOCRINE & METABOLIC DISORDERS INSTITUTE PLLC

NPI Number: 1457322661

Clasification: Internal Medicine (207RE0101X)

Specialization: Endocrinology, Diabetes & Metabolism

Address:
910 MARY VANCE DRIVE
TUPELO, MS
ZIP 38801

Phone Number: (662) 377-6275



Detailed Information

ENDOCRINE & METABOLIC DISORDERS INSTITUTE PLLC is an endocrinology, diabetes & metabolism internist in Tupelo, MS. The provider is an internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. The assigned NPI number for this provider is 1457322661 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

910 MARY VANCE DRIVE
TUPELO, MS
ZIP 38801-000
Phone: (662) 377-6275
Fax: (662) 377-6299

The provider's authorized official is Jayant Dey .
The authorized official title is Md and has the following contact phone number (662) 377-6275.

The enumeration date for this NPI number is 1/27/2006 and was last updated on 4/26/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1457322661 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name ENDOCRINE & METABOLIC DISORDERS INSTITUTE PLLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 910 MARY VANCE DRIVE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name TUPELO The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name MS The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 388010000 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 6623776275 The telephone number associated with the location address of the provider being identified.
11 Provider Business Practice Location Address Fax Number 6623776299 The fax number associated with the location address of the provider being identified.
12 Provider Enumeration Date 1/27/2006 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 4/26/2012 The date that a record was last updated or changed.
14 Authorized Official Last Name DEY The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name JAYANT The first name of the authorized official.
16 Authorized Official Title or Position MD The title or position of the authorized official.
17 Authorized Official Telephone Number 6623776275 The 10-position telephone number of the authorized official.
18 Healthcare Provider Taxonomy Code 1 207RE0101X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Healthcare Provider Primary Taxonomy Switch 1 Y
20 Is Organization Subpart N
21 Authorized Official Credential Text MD
22 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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