Provider Demographics
NPI:1619200318
Name:BILOXI URGENT CARE CENTER LLC
Entity type:Organization
Organization Name:BILOXI URGENT CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:228-374-7888
Mailing Address - Street 1:201 LAMEUSE ST
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-3107
Mailing Address - Country:US
Mailing Address - Phone:228-374-7888
Mailing Address - Fax:
Practice Address - Street 1:201 LAMEUSE ST
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-3107
Practice Address - Country:US
Practice Address - Phone:228-374-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-12
Last Update Date:2009-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09295261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019091Medicaid
MS1558396010OtherINDIVIDUAL NPI
MS09295Medicare UPIN