Healthcare Provider Details

I. General information

NPI: 1316036973
Provider Name (Legal Business Name): BATESVILLE EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 EUREKA ST
BATESVILLE MS
38606-2533
US

IV. Provider business mailing address

314 WESTMORELAND CIR
BATESVILLE MS
38606-8456
US

V. Phone/Fax

Practice location:
  • Phone: 601-573-0386
  • Fax: 662-563-2189
Mailing address:
  • Phone: 601-573-0386
  • Fax: 662-563-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number12101
License Number StateMS

VIII. Authorized Official

Name: ROBERT S CORKERN
Title or Position: PRESIDENT
Credential: MD
Phone: 601-573-0386