Healthcare Provider Details

I. General information

NPI: 1780809251
Provider Name (Legal Business Name): EZE PS FAMILY MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 STARK ROAD
STARKVILLE MS
39759
US

IV. Provider business mailing address

900 STARK ROAD
STARKVILLE MS
39759
US

V. Phone/Fax

Practice location:
  • Phone: 662-323-4400
  • Fax: 662-323-4409
Mailing address:
  • Phone: 662-323-4400
  • Fax: 662-323-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PLACID M EZE
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 662-323-4400