Individual
PACITA R COSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
222 S 27TH AVE, HATTIESBURG, MS 39401-7165
(601) 450-3030
(601) 450-3031
Mailing address
PO BOX 1729, HATTIESBURG, MS 39403-1729
(601) 545-8700
(601) 582-5461
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13634
MS
207Q00000X
Family Medicine Physician
5754
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00112217
—
MS
01
—
080047101
RAILROAD MEDICARE
—
01
—
1558931
AMERICAN ADMIN GROUP
MS
01
—
512I080292
MEIDARE PTAN (PROVIDER TRANSACTION ACCESS NUMBER)
MS
Enumeration date
08/03/2006
Last updated
03/16/2009
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