=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902949803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEDIATRIX MEDICAL GROUP OF MISSISSIPPI, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2007
-----------------------------------------------------
Last Update Date | 08/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4566 S EASON BLVD
-----------------------------------------------------
City | TUPELO
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38801-6540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-377-4905
-----------------------------------------------------
Fax | 662-377-4906
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1300 SAWGRASS CORPORATE PKWY SUITE 200
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33323-2826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-243-3839
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ERIC MASON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 800-243-3839
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080N0001X
-----------------------------------------------------
Taxonomy Name | Neonatal-Perinatal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------