Healthcare Provider Details

I. General information

NPI: 1396929907
Provider Name (Legal Business Name): NEIGHBORHOOD MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W WOODROW WILSON AVE
JACKSON MS
39213-7681
US

IV. Provider business mailing address

350 W WOODROW WILSON AVE
JACKSON MS
39213-7681
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-0673
  • Fax:
Mailing address:
  • Phone: 601-982-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number851157
License Number StateMS

VIII. Authorized Official

Name: MR. MELVIN V. PRIESTER SR.
Title or Position: MEMBER
Credential: ESQUIRE
Phone: 601-353-2460