Healthcare Provider Details

I. General information

NPI: 1306256060
Provider Name (Legal Business Name): MINERAL SPRINGS HEALTH CARE,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2014
Last Update Date: 05/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 RIVER VIEW DR
IUKA MS
38852-8389
US

IV. Provider business mailing address

1448 RIVER VIEW DR
IUKA MS
38852-8389
US

V. Phone/Fax

Practice location:
  • Phone: 662-424-3290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12314
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12314
License Number StateMS

VIII. Authorized Official

Name: DR. MARGARET M GLYNN
Title or Position: PRESIDENT
Credential: MD
Phone: 662-424-3290