=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881119618
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARCHIPOIMEN PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2017
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2416 MOUNT PLEASANT RD
-----------------------------------------------------
City | HERNANDO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38632-2001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-560-5966
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2416 MOUNT PLEASANT RD
-----------------------------------------------------
City | HERNANDO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38632-2001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-560-5966
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | DR. MICHAEL BRIAN BAGWELL
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 662-422-1798
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------