Provider Demographics
NPI:1306062641
Name:SOUTHERN MS HEART CENTER,PA
Entity type:Organization
Organization Name:SOUTHERN MS HEART CENTER,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-872-4040
Mailing Address - Street 1:3704 BIENVILLE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5710
Mailing Address - Country:US
Mailing Address - Phone:228-872-4040
Mailing Address - Fax:228-872-3612
Practice Address - Street 1:3704 BIENVILLE BLVD STE B
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5710
Practice Address - Country:US
Practice Address - Phone:228-872-4040
Practice Address - Fax:228-872-3612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014546Medicaid
MS09014546Medicaid