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General NPI Number Information
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NPI Number | 1790316214
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Entity Type | Organization
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Legal Business Name | INDEPENDENT PHYSICIANS GROUP INC
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Dates
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Enumeration Date | 02/03/2020
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Last Update Date | 06/28/2020
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Provider Practice Location Address
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Address Line | 870 MAIN ST
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City | FAYETTE
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State | MS
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Zip | 39069-5695
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Country | US
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Telephone | 601-786-3401
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27
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City | CANTON
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State | MS
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Zip | 39046-0027
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Country | US
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Telephone | 601-832-5548
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Fax |
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Authorized Official
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Title or Position | MANAGER/CEO
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Name | WILLIAM TRULY
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Credential |
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Telephone | 601-829-0018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State |
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