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General NPI Number Information
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NPI Number | 1548655053
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI UROLOGY OUTPATIENT SURGERY CENTER, LLC
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 501 MARSHALL ST SUITE 201
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City | JACKSON
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State | MS
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Zip | 39202-1651
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Country | US
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Telephone | 601-353-9900
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Fax | 601-353-3654
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Provider Business Mailing Address
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Address Line | 501 MARSHALL ST SUITE 201
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City | JACKSON
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State | MS
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Zip | 39202-1651
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Country | US
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Telephone | 601-353-9900
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Fax | 601-353-3654
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Authorized Official
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Title or Position | OWNER
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Name | DR. HAROLD J BLALOCK
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Credential | MD
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Telephone | 601-353-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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