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General NPI Number Information
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NPI Number | 1750308250
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Entity Type | Organization
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Legal Business Name | SOUTH MISSISSIPPI URGENT CARE
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 3661 SANGANI BLVD SUITE E
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City | DLBERVILLE
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State | MS
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Zip | 39540
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Country | US
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Telephone | 228-354-0022
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Fax | 228-354-0088
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Provider Business Mailing Address
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Address Line | 3661 SANGANI BLVD. SUITE E
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City | DLBERVILLE
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State | MS
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Zip | 39540
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Country | US
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Telephone | 228-354-0022
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Fax | 228-354-0088
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AMY ALI
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Credential | FNP
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Telephone | 228-539-2399
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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 | MS
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