Healthcare Provider Details

I. General information

NPI: 1750308250
Provider Name (Legal Business Name): SOUTH MISSISSIPPI URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 SANGANI BLVD SUITE E
DLBERVILLE MS
39540
US

IV. Provider business mailing address

3661 SANGANI BLVD. SUITE E
DLBERVILLE MS
39540
US

V. Phone/Fax

Practice location:
  • Phone: 228-354-0022
  • Fax: 228-354-0088
Mailing address:
  • Phone: 228-354-0022
  • Fax: 228-354-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. AMY ALI
Title or Position: OWNER
Credential: FNP
Phone: 228-539-2399