MEDICARE: CENTER OF INFECTIOUS DISEASE EXCELLENCE

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
1	207RI0200X	Infectious Disease Physician

General Provider Information

NPI Number	:	1235329020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER OF INFECTIOUS DISEASE EXCELLENCE

Provider Business Mailing Address
First Line	:	1040 RIVER OAKS DR
Second Line	:	SUITE 303
City	:	JACKSON
State	:	MS
Zip	:	39232-9530
Country	:	US
Telephone Number	:	601-936-0706
Fax Number	:	601-936-6150

Provider Business Practice Location Address
First Line	:	1040 RIVER OAKS DR
Second Line	:	SUITE 303
City	:	JACKSON
State	:	MS
Zip	:	39232-9530
Country	:	US
Telephone Number	:	601-936-0706
Fax Number	:	601-936-6150

Authorized Official
Title or Position	:	REGIONAL MANAGER
Name	:	BRAD SINCLAIR
Credential	:
Telephone Number	:	601-936-3102

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	07/27/2007

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Directions to “CENTER OF INFECTIOUS DISEASE EXCELLENCE ” Practice Location

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