=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780778928
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAREN M BRUCE MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 02/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 SIMPSON HIGHWAY 149 SUITE 350
-----------------------------------------------------
City | MAGEE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39111-3841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-849-1200
-----------------------------------------------------
Fax | 601-849-3112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 SIMPSON HIGHWAY 149 SUITE 350
-----------------------------------------------------
City | MAGEE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39111-3841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-849-1200
-----------------------------------------------------
Fax | 601-849-3112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KAREN HEMPHILL BRUCE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 601-849-1200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 18675
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------