Healthcare Provider Details

I. General information

NPI: 1528474780
Provider Name (Legal Business Name): FLOWOOD RIVER OAKS HMA MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 RIVER OAKS DR STE. 101
FLOWOOD MS
39232-9530
US

IV. Provider business mailing address

1080 RIVER OAKS DR STE. B-104
FLOWOOD MS
39232-9779
US

V. Phone/Fax

Practice location:
  • Phone: 601-933-5405
  • Fax: 601-933-5407
Mailing address:
  • Phone: 601-936-3121
  • Fax: 601-936-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATOYA SATCHER
Title or Position: AREA MANAGER
Credential:
Phone: 601-936-3121