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General NPI Number Information
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NPI Number | 1255901591
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Entity Type | Organization
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Legal Business Name | BLUEHEALTH BAPTIST, LLC
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 401 BAPTIST DR STE 110
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City | MADISON
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State | MS
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Zip | 39110-2009
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Country | US
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Telephone | 601-664-4300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 320339
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City | FLOWOOD
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State | MS
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Zip | 39232-0339
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BETHANY UNGO
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Credential | RN, MSN, JD
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Telephone | 601-664-4545
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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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