Healthcare Provider Details

I. General information

NPI: 1689813339
Provider Name (Legal Business Name): MISSISSIPPI EM I MEDICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MARION AVE
MCCOMB MS
39648-2705
US

IV. Provider business mailing address

PO BOX 37731
PHILADELPHIA PA
19101-5031
US

V. Phone/Fax

Practice location:
  • Phone: 601-249-1180
  • Fax:
Mailing address:
  • Phone: 800-355-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GREGORY BYRNE
Title or Position: OWNER
Credential: M.D.
Phone: 214-712-2000