Healthcare Provider Details

I. General information

NPI: 1508029778
Provider Name (Legal Business Name): VINOD K ANAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARSHALL STREET SUITE 602
JACKSON MS
39202
US

IV. Provider business mailing address

PO BOX 1000 501 MARSHALL STREET SUITE 602
JACKSON MS
39215
US

V. Phone/Fax

Practice location:
  • Phone: 601-969-1910
  • Fax: 601-969-1913
Mailing address:
  • Phone: 601-969-1910
  • Fax: 601-969-1913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number09754
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number09754
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number09754
License Number StateMS

VIII. Authorized Official

Name: MRS. HELEN MOSS MARSHALL
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 601-969-1910