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General NPI Number Information
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NPI Number | 1912165523
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Entity Type | Organization
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Legal Business Name | MEDICAL CLINIC OF MISSISSIPPI
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 6050 I-55 NORTH FRONTAGE RD
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City | JACKSON
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State | MS
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Zip | 39211
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Country | US
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Telephone | 601-957-5150
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Fax | 601-957-5161
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Provider Business Mailing Address
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Address Line | 6050 I-55 NORTH FRONTAGE RD
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City | JACKSON
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State | MS
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Zip | 39211
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Country | US
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Telephone | 601-957-5150
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Fax | 601-957-5161
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Authorized Official
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Title or Position | DOCTOR
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Name | MR. DINESH KUMAN GOEL
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Credential | M.D.,
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Telephone | 601-957-5150
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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 | 07606
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License Number State | MS
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