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General NPI Number Information
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NPI Number | 1801010988
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Entity Type | Organization
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Legal Business Name | STATE OF MS UMC NEWBORN TRANSPORT
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2500 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-815-5207
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-815-5207
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF NEWBORN TRANSPORT
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Name | DR. PHILLIP RHODES
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Credential | MD
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Telephone | 601-815-5207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 00018960
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License Number State | MS
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