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General NPI Number Information
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NPI Number | 1871883223
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Entity Type | Organization
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Legal Business Name | MEDSERVE, PA
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | MANHATTAN NURSING AND REHABILITATION CENTER 4540 MANHATTAN RD
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City | JACKSON
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State | MS
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Zip | 39206
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Country | US
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Telephone | 601-206-0901
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Fax | 888-240-6288
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Provider Business Mailing Address
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Address Line | 200 AMITY LN
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City | BRANDON
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State | MS
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Zip | 39047
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Country | US
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Telephone | 601-206-0901
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Fax | 888-240-6288
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Authorized Official
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Title or Position | PHYSICIAN, OWNER
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Name | TODD L FULCHER
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Credential | MD, CMD
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Telephone | 601-206-0901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12503
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License Number State | MS
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