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General NPI Number Information
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NPI Number | 1215572581
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Entity Type | Organization
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Legal Business Name | SPECTRUM ACADEMY
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Dates
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Enumeration Date | 11/11/2019
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Last Update Date | 11/11/2019
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Provider Practice Location Address
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Address Line | 2510 LAKELAND TER
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City | JACKSON
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State | MS
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Zip | 39216-4702
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Country | US
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Telephone | 601-982-7827
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Fax | 601-822-0303
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Provider Business Mailing Address
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Address Line | PO BOX 12347
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City | JACKSON
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State | MS
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Zip | 39236-2347
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Country | US
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Telephone | 601-982-7827
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Fax |
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | BECCA PEDRON
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Credential |
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Telephone | 601-982-7827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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