MEDICARE: HEEERS, PA

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
1	261Q00000X	Clinic/Center	13888	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215933346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEEERS, PA

Provider Business Mailing Address
First Line	:	1814 HOSPITAL DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39204-3410
Country	:	US
Telephone Number	:	601-373-2940
Fax Number	:	601-373-2720

Provider Business Practice Location Address
First Line	:	1814 HOSPITAL DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39204-3410
Country	:	US
Telephone Number	:	601-373-2940
Fax Number	:	601-373-2720

Authorized Official
Title or Position	:	OWNER AND PRESIDENT
Name	:	DR. HURSIE J DAVIS-SULLIVAN
Credential	:	M.D.
Telephone Number	:	601-373-2940

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	11/09/2010

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Directions to “HEEERS, PA ” Practice Location

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