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General NPI Number Information
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NPI Number | 1568415560
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI SPORTS MEDICINE & ORTHOPAEDIC CENTER
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 1325 E FORTIFICATION ST
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City | JACKSON
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State | MS
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Zip | 39202-2442
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Country | US
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Telephone | 601-949-9106
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Fax | 601-351-5980
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Provider Business Mailing Address
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Address Line | 1325 E FORTIFICATION ST
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City | JACKSON
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State | MS
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Zip | 39202-2442
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Country | US
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Telephone | 601-354-4488
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Fax | 601-351-5980
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Authorized Official
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Title or Position | CEO
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Name | MEREDITH GORE WARF
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Credential |
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Telephone | 601-605-5393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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