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General NPI Number Information
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NPI Number | 1952604811
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Entity Type | Organization
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Legal Business Name | FIRST INTERMED CORPORATION
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 12/30/2010
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Provider Practice Location Address
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Address Line | 106 LAKE VISTA PLACE
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City | BRANDON
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State | MS
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Zip | 39047-0000
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Country | US
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Telephone | 601-919-2924
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Fax |
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Provider Business Mailing Address
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Address Line | 308 CORPORATE DR
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City | RIDGELAND
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State | MS
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Zip | 39157-8803
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Country | US
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Telephone | 601-898-7500
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | SAM SCOTT
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Credential |
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Telephone | 601-898-7525
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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 |
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License Number State |
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