Organization
LUCEDALE OB/GYN CENTER
Active
Other names
Obstetrics & Gynecology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN RUTLEDGE (AO)
(601) 947-1330
Entity
Organization
Contact information
Practice address
859 WINTER ST STE A, LUCEDALE, MS 39452-6603
(601) 947-6000
Mailing address
PO BOX 1007, LUCEDALE, MS 39452-1007
(601) 947-6000
(601) 947-9436
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014803
—
MS
01
—
C02852
MEDICARE PART B
MS
Enumeration date
08/18/2006
Last updated
02/04/2020
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