Organization
HEAD AND NECK SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES EDWIN GUICE III M.D. (PRESIDENT)
(601) 268-5131
Entity
Organization
Contact information
Practice address
107 MILLSAPS DR, HATTIESBURG, MS 39402-1348
(601) 268-5131
(601) 268-5138
Mailing address
107 MILLSAPS DRIVE, HATTIESBURG, MS 39402
(601) 268-5131
(601) 268-5138
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770145
—
MS
01
—
49003039
H&N RAILROAD MEDICARE NUM
MS
Enumeration date
11/30/2006
Last updated
02/04/2010
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