Healthcare Provider Details

I. General information

NPI: 1932447968
Provider Name (Legal Business Name): KEYSTONE HOSPITALIST SERVICES OF MS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR
TYLERTOWN MS
39667-2022
US

IV. Provider business mailing address

P O BOX 742385
ATLANTA GA
30374-2385
US

V. Phone/Fax

Practice location:
  • Phone: 601-876-2122
  • Fax:
Mailing address:
  • Phone: 904-482-1070
  • Fax: 904-482-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: GLENN ADAMS
Title or Position: PRESIDENT
Credential:
Phone: 800-669-2640