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General NPI Number Information
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NPI Number | 1467149658
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Entity Type | Organization
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Legal Business Name | CENTRAL MISSISSIPPI VASCULAR CARE, LLC
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Dates
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Enumeration Date | 04/19/2023
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 2080 S FRONTAGE RD
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City | VICKSBURG
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State | MS
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Zip | 39180-5328
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Country | US
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Telephone | 601-228-8681
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 PALM HARBOR BLVD STE A
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City | PALM HARBOR
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State | FL
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Zip | 34683-1930
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Country | US
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Telephone | 727-474-0090
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Fax | 727-474-0055
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL PIERCE
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Credential | MD
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Telephone | 601-228-8681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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