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General NPI Number Information
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NPI Number | 1114471570
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Entity Type | Organization
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Legal Business Name | TELEMEDICINE SERVICES OF MISSISSIPPI
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 09/05/2016
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Provider Practice Location Address
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Address Line | 2355B RIVER OAKS BLVD
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City | JACKSON
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State | MS
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Zip | 39211-3015
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Country | US
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Telephone | 601-543-2022
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Fax |
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Provider Business Mailing Address
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Address Line | 2355B RIVER OAKS BLVD
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City | JACKSON
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State | MS
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Zip | 39211-3015
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Country | US
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Telephone | 601-543-2022
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. ROBERT WHITLEY
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Credential |
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Telephone | 601-543-2022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 895073
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 895073
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 895073
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License Number State | MS
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