Healthcare Provider Details

I. General information

NPI: 1811592454
Provider Name (Legal Business Name): NORTH MISSISSIPPI VASCULAR CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HOSPITAL DR STE 4A
COLUMBUS MS
39705-1901
US

IV. Provider business mailing address

3001 PALM HARBOR BLVD STE A
PALM HARBOR FL
34683-1930
US

V. Phone/Fax

Practice location:
  • Phone: 662-368-1169
  • Fax: 662-570-1492
Mailing address:
  • Phone: 727-474-0090
  • Fax: 727-474-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN KING
Title or Position: PRESIDENT
Credential: MD
Phone: 662-368-1169