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General NPI Number Information
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NPI Number | 1275567281
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Entity Type | Organization
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Legal Business Name | FIRST INTERMED CORPORATION
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 7300 S SIWELL RD
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City | BYRAM
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State | MS
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Zip | 39272-9772
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Country | US
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Telephone | 601-373-1234
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Fax | 601-373-1397
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Provider Business Mailing Address
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Address Line | 7300 S SIWELL RD
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City | BYRAM
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State | MS
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Zip | 39272-9772
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Country | US
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Telephone | 601-373-1234
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Fax | 601-373-1397
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Authorized Official
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Title or Position | CFO
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Name | SAM SCOTT
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Credential |
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Telephone | 601-898-7525
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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 | MS
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