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Organization
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Active
Organization
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Active
Other names
Ellisville Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES T CANIZARO (C.F.O. / VICE PRESIDENT)
(601) 399-6139
Entity
Organization
Contact information
Practice address
1203 AVENUE B, ELLISVILLE, MS 39437-2080
(601) 477-8553
(601) 477-9158
Mailing address
1203 AVENUE B, ELLISVILLE, MS 39437-2080
(601) 477-8553
(601) 477-9158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
NULL
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
Other
Enumeration date
10/31/2012
Last updated
10/31/2012
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