MEDICARE: MEDICAL SYSTEMS MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	261QM1300X	Multi-Specialty Clinic/Center
3	261QP2300X	Primary Care Clinic/Center
4	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1740555267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL SYSTEMS MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	129 CENTER ST STE B
Second Line	:
City	:	RICHLAND
State	:	MS
Zip	:	39218-4800
Country	:	US
Telephone Number	:	601-992-9898
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 CENTER ST STE B
Second Line	:
City	:	RICHLAND
State	:	MS
Zip	:	39218-4800
Country	:	US
Telephone Number	:	601-992-9898
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDWIN BLAIR MARBLE
Credential	:
Telephone Number	:	769-233-7141

Provider Enumeration Date	:	03/16/2012
Last Update Date	:	06/23/2021

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