Healthcare Provider Details

I. General information

NPI: 1891880621
Provider Name (Legal Business Name): MS WOUND CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST
JACKSON MS
39202-2064
US

IV. Provider business mailing address

PO BOX 23757
JACKSON MS
39225-3757
US

V. Phone/Fax

Practice location:
  • Phone: 601-936-6001
  • Fax: 601-933-4389
Mailing address:
  • Phone: 601-936-6001
  • Fax: 601-936-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number StateMS

VIII. Authorized Official

Name: CAS HEATH III
Title or Position: MANAGING PHYSICIAN
Credential: MD
Phone: 601-936-6001