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General NPI Number Information
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NPI Number | 1053483735
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL MANAGEMENT OF MISSISSIPPI, INC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 501 MARSHALL ST SUITE 201
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City | JACKSON
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State | MS
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Zip | 39202-1651
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Country | US
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Telephone | 601-352-2273
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Fax | 601-353-4414
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Provider Business Mailing Address
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Address Line | 864 WILSON DR SUITE C
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City | RIDGELAND
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State | MS
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Zip | 39157-4512
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Country | US
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Telephone | 601-206-6100
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Fax | 601-206-6052
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Authorized Official
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Title or Position | DIRECTOR OF PATIENT'S ACCOUNTS
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Name | DONNA LAY
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Credential |
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Telephone | 601-352-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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