Healthcare Provider Details

I. General information

NPI: 1497217574
Provider Name (Legal Business Name): OMS CARE OF MS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 BRIARWOOD DR STE 400
JACKSON MS
39206-3062
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 350
NASHVILLE TN
37205-2216
US

V. Phone/Fax

Practice location:
  • Phone: 615-386-0064
  • Fax:
Mailing address:
  • Phone: 615-386-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD LELAND HUTTON EADIE
Title or Position: DIRECTOR
Credential:
Phone: 615-733-2064