Provider Demographics
NPI:1336229046
Name:SPINAL & NEUROLOGICAL SURGERY OF SOUTH MS
Entity type:Organization
Organization Name:SPINAL & NEUROLOGICAL SURGERY OF SOUTH MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONDAY
Authorized Official - Suffix:
Authorized Official - Credentials:CMM CMPE
Authorized Official - Phone:601-579-4453
Mailing Address - Street 1:PO BOX 17708
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404
Mailing Address - Country:US
Mailing Address - Phone:601-579-4453
Mailing Address - Fax:601-579-4460
Practice Address - Street 1:15190 COMMUNITY RD
Practice Address - Street 2:STE 300
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503
Practice Address - Country:US
Practice Address - Phone:228-831-2229
Practice Address - Fax:228-831-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3234Medicare ID - Type Unspecified