Provider Demographics
NPI:1548928443
Name:VEIN INSTITUTE OF SOUTH MISSISSIPPI PLLC
Entity type:Organization
Organization Name:VEIN INSTITUTE OF SOUTH MISSISSIPPI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:601-467-5340
Mailing Address - Street 1:6169 U S HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8631
Mailing Address - Country:US
Mailing Address - Phone:601-335-8368
Mailing Address - Fax:
Practice Address - Street 1:6169 U S HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8631
Practice Address - Country:US
Practice Address - Phone:601-335-8368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS800456806OtherDRIVERS LICENSE - MISSISSIPPI MOTOR VEHICLE COMMISSION
MS19031OtherMISSISSIPPI STATE BOARD OF MEDICAL LICENSURE