Healthcare Provider Details

I. General information

NPI: 1427063965
Provider Name (Legal Business Name): REGIONAL MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 AIRPORT RD N SUITE 204
FLOWOOD MS
39232-8827
US

IV. Provider business mailing address

1503 HIGHWAY 45 N
COLUMBUS MS
39705-2113
US

V. Phone/Fax

Practice location:
  • Phone: 601-936-7199
  • Fax: 601-936-7193
Mailing address:
  • Phone: 662-328-9623
  • Fax: 662-327-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK A FRILOUX
Title or Position: OWNER
Credential: MD
Phone: 662-328-9623