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Organization
MEDICAL FOUNDATION OF SOUTH MS
Active
Organization
MEDICAL FOUNDATION OF SOUTH MS
Active
Other names
Internal Medicine Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY ROBINSON (ADMINISTRATOR)
(228) 865-1453
Entity
Organization
Contact information
Practice address
1110 BROAD AVE, SUITE 700, GULFPORT, MS 39501-8907
(228) 864-0314
(228) 864-0425
Mailing address
1612 31ST AVE, GULFPORT, MS 39501-2750
(228) 865-1453
(228) 865-1451
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014379
—
MS
Enumeration date
06/22/2006
Last updated
04/02/2008
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