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Organization

MISSISSIPPI COAST ENDOSCOPY & AMBULATORY CENTER LLC

Active
Other names
Mississippi Coast Endoscopy & Ambulatory Surgical
Organization subpart
No

Provider details

NPI number
Authorized official
KATHERINE RENEE JUDKINS (VICE PRESIDENT)
(615) 240-3770
Entity
Organization

Contact information

Practice address
2406 CATALPA AVE, PASCAGOULA, MS 39567-1813
(228) 696-0818
(228) 696-0893
Mailing address
2406 CATALPA AVE, PASCAGOULA, MS 39567-1813
(228) 696-0893

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
019
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000050466
BCBS
MS
05
0770544
MS
01
169127800
DEPARTMENT OF LABOR
MS
01
490005347
RAILROAD MEDICARE
MS
Enumeration date
07/08/2006
Last updated
01/27/2023
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