# MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC
- **Other names:** Louisiana Center for Advanced Medicine
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1548720527
- **Legal business name:** MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC
- **Authorized official:** SPENCER K SULLIVAN MD (CEO/OWNER)
- **Authorized official phone:** (601) 499-0935

## Contact information

- **Practice address:** 2053 GAUSE BLVD E STE 200, SLIDELL, LA 70461-5451
- **Practice address phone:** (985) 259-8045
- **Practice address fax:** (601) 499-0311
- **Mailing address:** 7731 OLD CANTON RD STE B, MADISON, MS 39110-6115
- **Mailing address phone:** (601) 499-0935
- **Mailing address fax:** (601) 499-0311

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0002X | Clinic Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 03/25/2019
- **Last updated:** 09/25/2019