Organization
HEART HYPERTENSION CHOLESTEROL & DIABETES CARE LLC
Active
Other names
PRIMARY CARE PLUS
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN SMITH (CREDENTIALING MANAGER)
(502) 244-9859
Entity
Organization
Contact information
Practice address
15444 DEDEAUX RD STE B, GULFPORT, MS 39503-2637
(228) 832-9038
(228) 832-9990
Mailing address
15444 DEDEAUX RD STE B, GULFPORT, MS 39503-2637
(228) 832-9038
(228) 832-9990
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01050841
—
MS
01
—
329259
MEDICARE PTAN
MS
Enumeration date
10/10/2013
Last updated
10/05/2019
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