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General NPI Number Information
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NPI Number | 1376929901
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Entity Type | Organization
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Legal Business Name | SW MEDIACAL INC
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Dates
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Enumeration Date | 08/05/2015
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 2561 PASS RD SUITE D
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City | BILOXI
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State | MS
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Zip | 39531-2125
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Country | US
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Telephone | 228-594-8380
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Fax | 228-594-8393
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Provider Business Mailing Address
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Address Line | 2561 PASS RD SUITE D
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City | BILOXI
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State | MS
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Zip | 39531-2125
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Country | US
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Telephone | 228-594-8380
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Fax | 228-594-8393
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ELIZABETH METALF
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Credential |
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Telephone | 228-594-8380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 23941
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R791344
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 097339
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License Number State | MS
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