Healthcare Provider Details

I. General information

NPI: 1982160073
Provider Name (Legal Business Name): PROVISION PROCESSING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 SPRINGRIDGE RD STE M
CLINTON MS
39056-5611
US

IV. Provider business mailing address

6145 FERNCREEK DR
JACKSON MS
39211-2728
US

V. Phone/Fax

Practice location:
  • Phone: 601-715-0772
  • Fax:
Mailing address:
  • Phone: 601-715-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246YC3302X
TaxonomyPhysician Office Based Coding Specialist
License Number
License Number State

VIII. Authorized Official

Name: RENITA TRENISE ROUSER
Title or Position: BILLER
Credential:
Phone: 601-715-0772