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MISSISSIPPI CENTER FOR ADVANCED MEDICINE PC NPI 1508426917


NPI Information

NPI: 1508426917
Provider Name: MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 25D2118551

Address:
2053 GAUSE BLVD E STE 200
SLIDELL, LA
ZIP 70461
Phone: (985) 259-8045
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MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC is a specialist in Slidell, LA. The provider is 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. MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC NPI is 1508426917. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2053 GAUSE BLVD E STE 200
SLIDELL, LA
ZIP 70461-451
Phone: (985) 259-8045
Fax: (601) 499-0936

The provider's authorized official is Spencer K Sullivan .
The authorized official title is Ceo/owner and has the following contact phone number (601) 499-0935.

The CLIA number assigned to this NPI record is 25D2118551 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 6/18/2019 and was last updated on 6/18/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.