Organization
HATTIESBURG CLINIC, PA
Active
Organization
HATTIESBURG CLINIC, PA
Active
Other names
Laurel Dialysis Unit
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN N BATSON MD (EXECUTIVE DIRECTOR)
(601) 268-5601
Entity
Organization
Contact information
Practice address
1527 LARRY DR, LAUREL, MS 39440-1932
(601) 425-1853
(601) 425-1877
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 425-1853
(601) 425-1877
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050273
BLUE CROSS BLUE SHIELD MS
MS
05
—
00020338
—
MS
01
—
5000477
UNITED HEALTHCARE
MS
Enumeration date
07/09/2006
Last updated
10/07/2020
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