Healthcare Provider Details

I. General information

NPI: 1619088531
Provider Name (Legal Business Name): PHYSICIANS HOSPICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 GETWELL ST
MARKS MS
38646-9785
US

IV. Provider business mailing address

PO BOX 387
MARKS MS
38646-0387
US

V. Phone/Fax

Practice location:
  • Phone: 662-326-7323
  • Fax: 662-326-6348
Mailing address:
  • Phone: 662-326-7323
  • Fax: 662-326-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number055
License Number StateMS

VIII. Authorized Official

Name: DR. RICHARD E WALLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 662-326-3500