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General NPI Number Information
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NPI Number | 1669061032
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Entity Type | Organization
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Legal Business Name | THE CRANIAL PROSTHESIS CENTER OF MISSISSIPPI LLC
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 717 RICE RD STE G
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City | RIDGELAND
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State | MS
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Zip | 39157-3041
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Country | US
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Telephone | 601-790-7269
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Fax | 601-590-8991
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Provider Business Mailing Address
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Address Line | 717 RICE RD STE G
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City | RIDGELAND
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State | MS
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Zip | 39157-3041
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Country | US
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Telephone | 601-790-7269
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Fax | 601-590-8991
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Authorized Official
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Title or Position | OWNER
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Name | TIERRA STEPHENS
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Credential |
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Telephone | 769-237-0443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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