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General NPI Number Information
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NPI Number | 1184575532
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Entity Type | Organization
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Legal Business Name | BLAVO MEDICAL GROUP
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Dates
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Enumeration Date | 02/03/2026
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 3198 HIGHWAY 72 W
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City | CORINTH
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State | MS
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Zip | 38834-9303
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Country | US
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Telephone | 662-415-3242
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Fax |
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Provider Business Mailing Address
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Address Line | 3198 HIGHWAY 72 W
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City | CORINTH
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State | MS
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Zip | 38834-9303
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Country | US
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Telephone | 662-415-3242
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JASON E MCKELVEY
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Credential |
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Telephone | 662-415-3242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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