Healthcare Provider Details

I. General information

NPI: 1346590460
Provider Name (Legal Business Name): MEDICAL SYSTEMS MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SARBOROUGH ST SUITE A
RICHLAND MS
39218
US

IV. Provider business mailing address

120 SARBOROUGH ST SUITE A
RICHLAND MS
39218
US

V. Phone/Fax

Practice location:
  • Phone: 769-233-7141
  • Fax: 769-233-7726
Mailing address:
  • Phone: 769-233-7141
  • Fax: 769-233-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RON MUNDEN
Title or Position: PRESIDENT
Credential:
Phone: 769-233-7141