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General NPI Number Information
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NPI Number | 1235787185
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Entity Type | Organization
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Legal Business Name | INTEGRATED MEDICAL AND WELLNESS CLINIC OF MISSISSIPPI LLC
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 2556 MARCIA CT
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City | BILOXI
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State | MS
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Zip | 39531-2352
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Country | US
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Telephone | 228-248-0561
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Fax | 228-248-0562
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Provider Business Mailing Address
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Address Line | 2556 MARCIA CT
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City | BILOXI
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State | MS
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Zip | 39531-2352
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Country | US
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Telephone | 228-248-0561
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Fax | 228-248-0562
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DAVID F ROWE
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Credential |
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Telephone | 228-248-0561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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