Healthcare Provider Details

I. General information

NPI: 1174078554
Provider Name (Legal Business Name): TRUSTCARE PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073 HIGHWAY 51 STE 103
MADISON MS
39110-9085
US

IV. Provider business mailing address

1107 HIGHLAND COLONY PKWY STE 219
RIDGELAND MS
39157-6079
US

V. Phone/Fax

Practice location:
  • Phone: 601-707-3978
  • Fax:
Mailing address:
  • Phone: 601-707-3279
  • Fax: 601-707-3598

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: HEIDI BALLARD
Title or Position: CAO
Credential:
Phone: 601-707-3279