Organization
LAUREL PAIN CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY N BUIE (BILLING SUPERVISOR)
(601) 898-7530
Entity
Organization
Contact information
Practice address
1706 W 12TH ST, LAUREL, MS 39440-2559
(601) 369-2021
Mailing address
1706 W 12TH ST, LAUREL, MS 39440-2559
(601) 369-2021
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
16318
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09987586
—
MS
01
—
DF1770
RAILROAD MEDICARE
MS
Enumeration date
09/25/2006
Last updated
11/06/2012
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