Healthcare Provider Details

I. General information

NPI: 1346450749
Provider Name (Legal Business Name): CENTRAL MS MED EKG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CHADWICK DR
JACKSON MS
39204-3404
US

IV. Provider business mailing address

PO BOX 781299
SEBASTIAN FL
32978-1299
US

V. Phone/Fax

Practice location:
  • Phone: 772-581-6226
  • Fax: 772-581-5771
Mailing address:
  • Phone: 772-581-6226
  • Fax: 772-581-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JOHN BARRETT
Title or Position: MANAGER
Credential:
Phone: 772-581-6226