Organization
STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY GRIMSLEY (CFO)
(601) 496-9801
Entity
Organization
Contact information
Practice address
1410 E WOODROW WILSON AVE STE I, JACKSON, MS 39216-5114
(601) 984-6525
Mailing address
2500 N. STATE STREET, CBO - SUITE 4200, JACKSON, MS 39216-4500
(601) 496-9794
(601) 815-0434
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
08/12/2019
Last updated
08/12/2019
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