# INTERNAL MEDICINE CLINIC OF PICAYUNE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Center For Health Management
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528004322
- **Authorized official:** DR. STANFORD OWEN MD (MD)
- **Authorized official phone:** (228) 864-9669

## Contact information

- **Practice address:** 3300 15TH ST, GULFPORT, MS 39501-3901
- **Practice address phone:** (228) 864-9669
- **Practice address fax:** (228) 864-9774
- **Mailing address:** 3300 15TH ST, GULFPORT, MS 39501-3901
- **Mailing address phone:** (228) 864-9669
- **Mailing address fax:** (228) 864-9774

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 08597 | MS | Yes |

## Other

- **Enumeration date:** 06/21/2006
- **Last updated:** 08/22/2020