Healthcare Provider Details

I. General information

NPI: 1609951441
Provider Name (Legal Business Name): MEDICAL FOUNDATION OF SOUTH MS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2771 PASS RD
BILOXI MS
39531-2600
US

IV. Provider business mailing address

1612 31ST AVE
GULFPORT MS
39501-2750
US

V. Phone/Fax

Practice location:
  • Phone: 228-385-4645
  • Fax: 228-385-4695
Mailing address:
  • Phone: 228-864-8454
  • Fax: 228-865-1457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RANDY ROBINSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 228-864-8454