Healthcare Provider Details

I. General information

NPI: 1639539463
Provider Name (Legal Business Name): JFMC TAYLORSVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 PINE ST
TAYLORSVILLE MS
39168-5528
US

IV. Provider business mailing address

403 PINE ST
TAYLORSVILLE MS
39168-5528
US

V. Phone/Fax

Practice location:
  • Phone: 601-478-5020
  • Fax: 601-785-0205
Mailing address:
  • Phone: 601-785-0202
  • Fax: 601-785-0205

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: KAYE JONES
Title or Position: BUSINESS MANAGER
Credential:
Phone: 601-425-0092