Healthcare Provider Details

I. General information

NPI: 1538187414
Provider Name (Legal Business Name): LOUISVILLE MEDICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 E MAIN ST
LOUISVILLE MS
39339-2742
US

IV. Provider business mailing address

PO BOX 190
LOUISVILLE MS
39339-0190
US

V. Phone/Fax

Practice location:
  • Phone: 662-773-7500
  • Fax: 662-779-5006
Mailing address:
  • Phone: 662-773-7500
  • Fax: 662-779-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBIN J WRIGHT
Title or Position: CLINIC MANAGER
Credential:
Phone: 662-773-7500