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Organization
MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC
Active
Organization
MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC
Active
Parent organization
MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC
Other names
Louisiana Center for Advanced Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC
Authorized official
SPENCER K SULLIVAN MD (CEO/OWNER)
(601) 499-0935
Entity
Organization
Contact information
Practice address
2053 GAUSE BLVD E STE 200, SLIDELL, LA 70461-5451
(985) 259-8045
(601) 499-0311
Mailing address
7731 OLD CANTON RD STE B, MADISON, MS 39110-6115
(601) 499-0935
(601) 499-0311
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0002X
Clinic Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Enumeration date
03/25/2019
Last updated
09/25/2019
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