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General NPI Number Information
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NPI Number | 1912088295
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Entity Type | Organization
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Legal Business Name | UROLOGY CLINIC OF MERIDIAN, P.A.
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 1302 20TH AVE
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City | MERIDIAN
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State | MS
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Zip | 39301-4120
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Country | US
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Telephone | 601-693-1055
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Fax | 601-482-5312
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Provider Business Mailing Address
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Address Line | 1302 20TH AVE
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City | MERIDIAN
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State | MS
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Zip | 39301-4120
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Country | US
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Telephone | 601-693-1055
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Fax | 601-482-5312
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK T PHILLIPS
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Credential | M.D.
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Telephone | 601-693-1055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 11068
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License Number State | MS
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