Healthcare Provider Details

I. General information

NPI: 1205208790
Provider Name (Legal Business Name): COMMUNITY MEDICAL PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 RATLIFF ST
LUCEDALE MS
39452-6537
US

IV. Provider business mailing address

PO BOX 889
LUCEDALE MS
39452-0889
US

V. Phone/Fax

Practice location:
  • Phone: 601-947-1330
  • Fax: 601-947-1331
Mailing address:
  • Phone: 601-947-1330
  • Fax: 601-947-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MIKE HUBER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 601-947-1330