# MEDSERVE, PA

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

## Provider details

- **NPI number:** 1871883223
- **Authorized official:** TODD L FULCHER MD, CMD (PHYSICIAN, OWNER)
- **Authorized official phone:** (601) 206-0901

## Contact information

- **Practice address:** MANHATTAN NURSING AND REHABILITATION CENTER, 4540 MANHATTAN RD, JACKSON, MS 39206
- **Practice address phone:** (601) 206-0901
- **Practice address fax:** (888) 240-6288
- **Mailing address:** 200 AMITY LN, BRANDON, MS 39047
- **Mailing address phone:** (601) 206-0901
- **Mailing address fax:** (888) 240-6288

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 12503 | MS | Yes |

## Other

- **Enumeration date:** 04/19/2011
- **Last updated:** 01/13/2022