1588497705 NPI number — SEAHORSE ANESTHESIA

Table of content: (NPI 1588497705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588497705 NPI number — SEAHORSE ANESTHESIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEAHORSE ANESTHESIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588497705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GULFPORT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39506-6127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-806-7030
Provider Business Mailing Address Fax Number:
228-594-1765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2781 SWITZER RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39531-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-806-7030
Provider Business Practice Location Address Fax Number:
228-594-1765
Provider Enumeration Date:
08/22/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TSANG
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MD/OWNER
Authorized Official Telephone Number:
228-678-6038

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)