Healthcare Provider Details

I. General information

NPI: 1316168339
Provider Name (Legal Business Name): MEDICAL CARE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-5732
US

IV. Provider business mailing address

3434 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-5732
US

V. Phone/Fax

Practice location:
  • Phone: 228-875-1599
  • Fax: 228-875-1124
Mailing address:
  • Phone: 228-875-1599
  • Fax: 228-875-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME14877
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00086
License Number StateMS

VIII. Authorized Official

Name: JANUS KULPA
Title or Position: OWNER
Credential: M.D.
Phone: 228-875-1599