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Organization
MISSISSIPPI COAST ENDOSCOPY & AMBULATORY CENTER LLC
Active
Organization
MISSISSIPPI COAST ENDOSCOPY & AMBULATORY CENTER LLC
Active
Other names
Mississippi Coast Endoscopy & Ambulatory Surgical
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE RENEE JUDKINS (VICE PRESIDENT)
(615) 240-3770
Entity
Organization
Contact information
Practice address
2406 CATALPA AVE, PASCAGOULA, MS 39567-1813
(228) 696-0818
(228) 696-0893
Mailing address
2406 CATALPA AVE, PASCAGOULA, MS 39567-1813
(228) 696-0893
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
019
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050466
BCBS
MS
05
—
0770544
—
MS
01
—
169127800
DEPARTMENT OF LABOR
MS
01
—
490005347
RAILROAD MEDICARE
MS
Enumeration date
07/08/2006
Last updated
01/27/2023
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