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Organization
MISSISSIPPI UROLOGY CLINIC, PLLC
Active
Organization
MISSISSIPPI UROLOGY CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY KEMPF POOLE RN, FACHE (CHIEF ADMINISTRATIVE OFFICER)
(601) 985-3169
Entity
Organization
Contact information
Practice address
501 MARHSALL ST, SUITE 301, JACKSON, MS 39202
(601) 353-9900
(601) 985-3199
Mailing address
501 MARHSALL ST, SUITE 301, JACKSON, MS 39202
(601) 353-9900
(601) 985-3199
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD5655
MEDICARE RR
MS
Enumeration date
07/05/2006
Last updated
10/11/2018
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