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General NPI Number Information
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NPI Number | 1972857548
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Entity Type | Organization
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Legal Business Name | CSC MEDICAL, LLC
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 02/27/2014
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Provider Practice Location Address
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Address Line | 1126 COUNTRY CLUB RD
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City | MCCOMB
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State | MS
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Zip | 39648-5952
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Country | US
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Telephone | 601-250-0139
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Fax | 601-250-0139
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Provider Business Mailing Address
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Address Line | 1126 COUNTRY CLUB RD
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City | MCCOMB
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State | MS
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Zip | 39648-5952
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Country | US
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Telephone | 601-250-0139
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Fax | 601-250-0139
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. LINDA COCKRELL
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Credential | FNP,BC
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Telephone | 601-259-7345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R747936
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License Number State | MS
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