Healthcare Provider Details

I. General information

NPI: 1609934272
Provider Name (Legal Business Name): E D MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 OAK TREE CV SUITE 101
HERNANDO MS
38632-1198
US

IV. Provider business mailing address

2007 OAK TREE CV SUITE 201
HERNANDO MS
38632-1198
US

V. Phone/Fax

Practice location:
  • Phone: 662-429-8802
  • Fax: 662-429-8698
Mailing address:
  • Phone: 662-429-8802
  • Fax: 662-429-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberM14539
License Number StateMS

VIII. Authorized Official

Name: SANDRA M JONES
Title or Position: OFFICE MANAGER
Credential:
Phone: 662-429-8802