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General NPI Number Information
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NPI Number | 1295488393
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Entity Type | Organization
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Legal Business Name | ON DEMAND MEDICAL TESTING II
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Dates
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Enumeration Date | 01/28/2022
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 4510 OFFICE PARK DR
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City | JACKSON
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State | MS
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Zip | 39206-6016
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Country | US
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Telephone | 601-966-5601
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Fax |
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Provider Business Mailing Address
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Address Line | 4510 OFFICE PARK DR
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City | JACKSON
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State | MS
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Zip | 39206-6016
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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 | CEO
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Name | RONALD HEWITT
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Credential |
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Telephone | 601-966-5601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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