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General NPI Number Information
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NPI Number | 1942591128
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Entity Type | Organization
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Legal Business Name | REAL SOLUTILONS, LLC
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 04/22/2011
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Provider Practice Location Address
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Address Line | 831 HWY 80 W.
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City | JACKSON
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State | MS
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Zip | 39204
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Country | US
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Telephone | 601-949-5693
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Fax | 601-949-5695
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Provider Business Mailing Address
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Address Line | 831 HWY 80 W.
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City | JACKSON
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State | MS
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Zip | 39204
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Country | US
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Telephone | 601-949-5693
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Fax | 601-949-5695
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LATRICIA OVERTON DIXON
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Credential |
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Telephone | 601-949-5693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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