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NPI Code Detail

MEDICARE: WESTMORELAND DERMATOLOGY AND SURGERY CENTER

MEDICARE: WESTMORELAND DERMATOLOGY AND SURGERY CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerR798833MS

General Provider Information

NPI Number : 1013161132
Entity Type Code : Organization
Provider Name (Legal Business Name) : WESTMORELAND DERMATOLOGY AND SURGERY CENTER
Provider Business Mailing Address
First Line : 2110 5TH ST N
Second Line : PO BOX 8695
City : COLUMBUS
State : MS
Zip : 39705-2210
Country : US
Telephone Number : 662-243-2435
Fax Number : 662-328-7037
Provider Business Practice Location Address
First Line : 2110 5TH ST N
Second Line :
City : COLUMBUS
State : MS
Zip : 39705-2210
Country : US
Telephone Number : 662-243-2435
Fax Number : 662-328-7037
Authorized Official
Title or Position : ADMINISTRATOR
Name : KAREN VICKERS
Credential :
Telephone Number : 662-243-2435
Provider Enumeration Date : 11/17/2008
Last Update Date : 11/17/2008

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Directions to “WESTMORELAND DERMATOLOGY AND SURGERY CENTER ” Practice Location

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