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NPI Code Detail

MEDICARE: ON DEMAND MEDICAL TESTING II

MEDICARE: ON DEMAND MEDICAL TESTING II
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
1261QM1300XMulti-Specialty Clinic/Center
2261Q00000XClinic/Center

General Provider Information

NPI Number : 1295488393
Entity Type Code : Organization
Provider Name (Legal Business Name) : ON DEMAND MEDICAL TESTING II
Provider Business Mailing Address
First Line : 4510 OFFICE PARK DR
Second Line :
City : JACKSON
State : MS
Zip : 39206-6016
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4510 OFFICE PARK DR
Second Line :
City : JACKSON
State : MS
Zip : 39206-6016
Country : US
Telephone Number : 601-966-5601
Fax Number :
Authorized Official
Title or Position : CEO
Name : RONALD HEWITT
Credential :
Telephone Number : 601-966-5601
Provider Enumeration Date : 01/28/2022
Last Update Date : 01/28/2022

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Directions to “ON DEMAND MEDICAL TESTING II ” Practice Location

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