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General NPI Number Information
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NPI Number | 1245781616
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Entity Type | Organization
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Legal Business Name | PRIMARY MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 5000 HIGHWAY 39 N
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City | MERIDIAN
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State | MS
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Zip | 39301-1021
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Country | US
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Telephone | 601-646-0898
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 HIGHWAY 39 N
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City | MERIDIAN
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State | MS
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Zip | 39301-1021
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Country | US
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Telephone | 601-646-0898
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD ALLEN NANCE
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Credential | DO
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Telephone | 205-393-3311
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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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