Healthcare Provider Details

I. General information

NPI: 1760633309
Provider Name (Legal Business Name): MISSISSIPPI EM-I MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 RIVER OAKS DR
JACKSON MS
39232-9553
US

IV. Provider business mailing address

18167 US HIGHWAY 19 N STE 650
CLEARWATER FL
33764-3528
US

V. Phone/Fax

Practice location:
  • Phone: 601-963-1098
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY J BYRNE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-712-2000