Healthcare Provider Details

I. General information

NPI: 1104004910
Provider Name (Legal Business Name): SOUTHWEST MISSISSIPPI EMERGENCY PHYSICIANS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3549 LOWER CENTREVILLE RD
LIBERTY MS
39645-8294
US

IV. Provider business mailing address

3549 LOWER CENTREVILLE RD
LIBERTY MS
39645-8294
US

V. Phone/Fax

Practice location:
  • Phone: 601-657-4562
  • Fax: 601-657-4685
Mailing address:
  • Phone: 601-657-4562
  • Fax: 601-657-4685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number04834
License Number StateMS

VIII. Authorized Official

Name: DR. HENRY L LEWIS
Title or Position: PRESIDENT
Credential: MD
Phone: 601-657-4562