Healthcare Provider Details

I. General information

NPI: 1467235648
Provider Name (Legal Business Name): QUAD INTERMED COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 HIGHWAY 49 S
RICHLAND MS
39218-9446
US

IV. Provider business mailing address

308 CORPORATE DR
RIDGELAND MS
39157-8803
US

V. Phone/Fax

Practice location:
  • Phone: 601-664-1620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM M GRANTHAM
Title or Position: CEO
Credential: MD
Phone: 601-898-7530