Organization
PREMIER MEDICAL MANAGEMENT OF MISSISSIPPI, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA LAY (DIRECTOR OF PATIENT'S ACCOUNTS)
(601) 352-2273
Entity
Organization
Contact information
Practice address
501 MARSHALL ST, SUITE 201, JACKSON, MS 39202-1651
(601) 352-2273
(601) 353-4414
Mailing address
864 WILSON DR, SUITE C, RIDGELAND, MS 39157-4512
(601) 206-6100
(601) 206-6052
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770341
—
MS
01
—
490004328
RAILROAD MEDICARE
MS
Enumeration date
11/15/2006
Last updated
09/16/2011
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