Organization
KEYSTONE MEDICAL SERVICES OF MS, INC
Active
Other names
KEYSTONE MEDICAL SERVICES OF MISSISSIPPI, PA
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN ADAMS (PRESIDENT)
(800) 669-2640
Entity
Organization
Contact information
Practice address
233 MAGNOLIA ST, HAZLEHURST, MS 39083-2228
(601) 894-4541
Mailing address
PO BOX 281030, ATLANTA, GA 30384-1030
(904) 482-1070
(904) 482-1077
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05786560
MEDICAID MS - HWMH
MS
01
—
09100893
MEDICAID MS - NRMC
MS
01
—
1451096
MEDICAID LA - NATCHEZ
LA
01
—
C04505
MEDICARE
MS
Enumeration date
12/01/2006
Last updated
06/21/2018
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