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General NPI Number Information
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NPI Number | 1851271159
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI UROLOGY CLINIC, PLLC
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 1029 RIVER OAKS DR
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City | FLOWOOD
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State | MS
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Zip | 39232-9554
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Country | US
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Telephone | 601-353-9900
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Fax | 601-353-3654
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Provider Business Mailing Address
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Address Line | 501 MARSHALL ST STE 301
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City | JACKSON
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State | MS
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Zip | 39202-1687
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Country | US
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Telephone | 601-985-3169
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Fax | 601-353-3654
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Authorized Official
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Title or Position | PRESIDENT
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Name | HAROLD JASON BLALOCK
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Credential |
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Telephone | 601-985-3169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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