Healthcare Provider Details

I. General information

NPI: 1760905509
Provider Name (Legal Business Name): MEDICAL FOUNDATION OF CENTRAL MS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BAPTIST DR STE 206
MADISON MS
39110-2011
US

IV. Provider business mailing address

1600 N STATE ST STE 400
JACKSON MS
39202-1689
US

V. Phone/Fax

Practice location:
  • Phone: 601-973-1583
  • Fax: 601-973-1609
Mailing address:
  • Phone: 601-944-1717
  • Fax: 601-944-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN RHODES
Title or Position: PRESIDENT BAPTIST MEDICAL CLINICS
Credential:
Phone: 601-292-4261