Provider Demographics
NPI:1679910269
Name:ATTICUS GROUP LLC
Entity type:Organization
Organization Name:ATTICUS GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HEGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:769-798-7748
Mailing Address - Street 1:159 FOUNTAINS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6344
Mailing Address - Country:US
Mailing Address - Phone:601-859-8200
Mailing Address - Fax:601-859-1057
Practice Address - Street 1:159 FOUNTAINS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6344
Practice Address - Country:US
Practice Address - Phone:601-859-8200
Practice Address - Fax:601-859-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12242/2.1332B00000X, 332BP3500X, 3336C0004X, 3336H0001X
MS06155081333600000X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06155081OtherMEDICAID PHARMACY
MS7034750001Medicare NSC