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Organization

MISSISSIPPI EAR NOSE AND THROAT SURGICAL ASSOCIATES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JANICE KAY (BUSINESS MANAGER)
(601) 709-7700
Entity
Organization

Contact information

Practice address
332 HIGHWAY 12 WEST, KOSCIUSKO, MS 39090-3209
(662) 289-1800
(662) 289-2486
Mailing address
501 MARSHALL STREET, SUITE 501, JACKSON, MS 39202-1615
(601) 709-7700
(601) 709-7701

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
C03111
MEDICARE GROUP
MS
Enumeration date
02/27/2012
Last updated
02/27/2012
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