Healthcare Provider Details

I. General information

NPI: 1346923646
Provider Name (Legal Business Name): RELIAS EMERGENCY MEDICINE SPECIALISTS OF PONTOTOC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 S MAIN ST
PONTOTOC MS
38863-3311
US

IV. Provider business mailing address

PO BOX 7058
TUPELO MS
38802-7058
US

V. Phone/Fax

Practice location:
  • Phone: 662-489-5510
  • Fax:
Mailing address:
  • Phone: 662-432-4106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAY HOWELL
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 662-432-4106