Organization
HATTIESBURG CLINIC, P.A
Active
Organization
HATTIESBURG CLINIC, P.A
Active
Other names
Silver Creek DialysisUnit
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN N BATSON (EXECUTIVE DIRECTOR)
(601) 264-6000
Entity
Organization
Contact information
Practice address
21 EMU LANE, SILVER CREEK, MS 39663
(601) 886-0072
(601) 886-0106
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 886-0072
(601) 886-0106
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00050718
BCBS
MS
05
—
5073750
—
MS
Enumeration date
06/17/2006
Last updated
02/23/2021
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