# MEDICAL FOUNDATION OF SOUTH MS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Internal Medicine Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245276740
- **Authorized official:** MR. RANDY ROBINSON (ADMINISTRATOR)
- **Authorized official phone:** (228) 865-1453

## Contact information

- **Practice address:** 1110 BROAD AVE, SUITE 700, GULFPORT, MS 39501-8907
- **Practice address phone:** (228) 864-0314
- **Practice address fax:** (228) 864-0425
- **Mailing address:** 1612 31ST AVE, GULFPORT, MS 39501-2750
- **Mailing address phone:** (228) 865-1453
- **Mailing address fax:** (228) 865-1451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/22/2006
- **Last updated:** 04/02/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 09014379 | — | MS |