# UNIVERSITY FAMILY MEDICINE ASSOCIATES, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093913634
- **Authorized official:** DIANE BEEBE MD (CHAIRMAN)
- **Authorized official phone:** (601) 984-5404

## Contact information

- **Practice address:** 1410 E WOODROW WILSON AVE, JACKSON, MS 39216-5114
- **Practice address phone:** (601) 984-5404
- **Practice address fax:** (601) 815-3771
- **Mailing address:** PO BOX 4999, JACKSON, MS 39296-4999
- **Mailing address phone:** (601) 984-5404
- **Mailing address fax:** (601) 815-3771

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/05/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 09014106 | — | MS |
| 05 | — | 09014130 | — | MS |