Healthcare Provider Details

I. General information

NPI: 1114471570
Provider Name (Legal Business Name): TELEMEDICINE SERVICES OF MISSISSIPPI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 09/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355B RIVER OAKS BLVD
JACKSON MS
39211-3015
US

IV. Provider business mailing address

2355B RIVER OAKS BLVD
JACKSON MS
39211-3015
US

V. Phone/Fax

Practice location:
  • Phone: 601-543-2022
  • Fax:
Mailing address:
  • Phone: 601-543-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number895073
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number895073
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number895073
License Number StateMS

VIII. Authorized Official

Name: MR. ROBERT WHITLEY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 601-543-2022