Healthcare Provider Details

I. General information

NPI: 1699484816
Provider Name (Legal Business Name): MISSISSIPPI BURN, HAND AND RECONSTRUCTION CENTERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N STATE ST STE 103
JACKSON MS
39202-2064
US

IV. Provider business mailing address

PO BOX 2204
MADISON MS
39130-2204
US

V. Phone/Fax

Practice location:
  • Phone: 833-672-8767
  • Fax: 800-967-9562
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DEREK CULNAN
Title or Position: OWNER
Credential: MD
Phone: 833-672-8767