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NPI Code Detail

MEDICARE: PRIMESOURCE NURSING SERVICES, INC

MEDICARE: PRIMESOURCE NURSING SERVICES, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner

General Provider Information

NPI Number : 1114583994
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIMESOURCE NURSING SERVICES, INC
Provider Business Mailing Address
First Line : PO BOX 6705
Second Line :
City : GULFPORT
State : MS
Zip : 39506-6705
Country : US
Telephone Number : 228-865-1330
Fax Number : 228-865-1331
Provider Business Practice Location Address
First Line : 2279 ATKINSON RD
Second Line :
City : BILOXI
State : MS
Zip : 39531-2209
Country : US
Telephone Number : 228-865-1330
Fax Number : 228-865-1331
Authorized Official
Title or Position : PRESIDENT
Name : RHETT PLAUCHE
Credential :
Telephone Number : 228-865-1330
Provider Enumeration Date : 05/16/2019
Last Update Date : 05/16/2019

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Directions to “PRIMESOURCE NURSING SERVICES, INC ” Practice Location

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