Provider Demographics
NPI:1841416070
Name:HEAD & NECK SURGICAL GROUP
Entity type:Organization
Organization Name:HEAD & NECK SURGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHRONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-932-5244
Mailing Address - Street 1:PO BOX 5345
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39296-5345
Mailing Address - Country:US
Mailing Address - Phone:601-932-5244
Mailing Address - Fax:601-939-0545
Practice Address - Street 1:1038 RIVER OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:601-932-5244
Practice Address - Fax:601-939-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02454Medicare PIN