Healthcare Provider Details

I. General information

NPI: 1124471131
Provider Name (Legal Business Name): 1ST STEP MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 ADAMS FARM RD
BELDEN MS
38826-7020
US

IV. Provider business mailing address

PO BOX 427
BELDEN MS
38826-0427
US

V. Phone/Fax

Practice location:
  • Phone: 662-322-0996
  • Fax: 662-205-4203
Mailing address:
  • Phone: 662-322-0996
  • Fax: 662-205-4203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number28794
License Number StateMS

VIII. Authorized Official

Name: MRS. BRENDA LYNN OSTRANDER
Title or Position: OFFICE MANGER
Credential:
Phone: 662-322-0996