Provider Demographics
NPI:1215100599
Name:S SONGCHAROEN MD, FACS, PLLC
Entity type:Organization
Organization Name:S SONGCHAROEN MD, FACS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONGCHAROEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SONGCHAROEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-981-2525
Mailing Address - Street 1:971 LAKELAND DR
Mailing Address - Street 2:SUITE 654
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4643
Mailing Address - Country:US
Mailing Address - Phone:601-981-2525
Mailing Address - Fax:601-981-3152
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:SUITE 315
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4643
Practice Address - Country:US
Practice Address - Phone:601-981-2525
Practice Address - Fax:601-981-3152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS240007802OtherRR MEDICARE
MS00015584Medicaid
MS1689615486OtherNPI INDIVIDUAL NUMBER
MS371563401FOtherBCBS OF MS
MS00015584Medicaid
MS371563401FOtherBCBS OF MS