Healthcare Provider Details

I. General information

NPI: 1073853578
Provider Name (Legal Business Name): HOSPITALMD OF MS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 E MADISON ST
HOUSTON MS
38851-2428
US

IV. Provider business mailing address

1002 E MADISON ST
HOUSTON MS
38851-2428
US

V. Phone/Fax

Practice location:
  • Phone: 662-456-4277
  • Fax:
Mailing address:
  • Phone: 662-456-4277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES BURNETTE
Title or Position: CEO
Credential:
Phone: 706-276-4741