=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205119278
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH SERVICES IN ACTION, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2011
-----------------------------------------------------
Last Update Date | 09/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 S. COMMERCE COVE
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-234-1374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 SOUTH COMMERCE COVE
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-234-1374
-----------------------------------------------------
Fax | 662-234-1305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | MRS. SUSAN GUNN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 662-234-1374
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | R566098
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------