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General NPI Number Information
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NPI Number | 1407121338
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Entity Type | Organization
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Legal Business Name | JFMC ELLISVILLE, LLC
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Dates
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Enumeration Date | 03/10/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 602 HILL ST
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City | ELLISVILLE
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State | MS
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Zip | 39437-2414
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Country | US
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Telephone | 601-719-0092
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Fax | 601-719-0473
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Provider Business Mailing Address
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Address Line | 602 HILL ST
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City | ELLISVILLE
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State | MS
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Zip | 39437-2414
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Country | US
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Telephone | 601-719-0092
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Fax | 601-719-0473
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KAYE D JONES
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Credential |
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Telephone | 601-719-0092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care 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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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