Healthcare Provider Details

I. General information

NPI: 1881119618
Provider Name (Legal Business Name): ARCHIPOIMEN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 MOUNT PLEASANT RD
HERNANDO MS
38632-2001
US

IV. Provider business mailing address

2416 MOUNT PLEASANT RD
HERNANDO MS
38632-2001
US

V. Phone/Fax

Practice location:
  • Phone: 662-560-5966
  • Fax:
Mailing address:
  • Phone: 662-560-5966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL BRIAN BAGWELL
Title or Position: SOLE MEMBER
Credential: DO
Phone: 662-422-1798