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General NPI Number Information
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NPI Number | 1124471131
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Entity Type | Organization
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Legal Business Name | 1ST STEP MEDICAL PC
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Dates
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Enumeration Date | 07/14/2016
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 3104 ADAMS FARM RD
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City | BELDEN
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State | MS
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Zip | 38826-7020
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Country | US
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Telephone | 662-322-0996
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Fax | 662-205-4203
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Provider Business Mailing Address
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Address Line | PO BOX 427
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City | BELDEN
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State | MS
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Zip | 38826-0427
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Country | US
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Telephone | 662-322-0996
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Fax | 662-205-4203
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Authorized Official
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Title or Position | OFFICE MANGER
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Name | MRS. BRENDA LYNN OSTRANDER
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Credential |
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Telephone | 662-322-0996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 28794
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License Number State | MS
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