OrganizationSt Michaels Urgent Care Of HattiesburgNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3700 Hardy St, Hattiesburg, MS 39402-1610(601) 602-2014PECOS EnrollmentBased on the most recent information from CMS, provider St Michaels Urgent Care Of Hattiesburg does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1124459136Provider TypeOrganizationFull NameSt Michaels Urgent Care Of HattiesburgSubpartYesEnumeration Date12/2/2013Last Updated9/6/2016Contact InformationPractice LocationPractice Address3700 Hardy St, Hattiesburg, MS 39402-1610Phone(601) 602-2014Fax(601) 602-2015Mailing LocationMailing Address3700 Hardy St, Hattiesburg, MS 39402-1610Phone(601) 602-2014Fax(601) 602-2015Authorized OfficialNameCooley, Marva Joyce (Credentialling Director)Phone(601) 909-2539Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseR875464MississippiCode174400000XDescriptionSpecialistOther Service ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID00776879DescriptionMedicaidIssuerUnlistedMississippi