Organization
JRCO, LLC
Active
Other names
CALEDONIA MEDICAL CARE
Organization subpart
No
Provider details
NPI number
Authorized official
ALVIN RAY BEEZLEY JR. D.O. (PROVIDER)
(662) 356-0320
Entity
Organization
Contact information
Practice address
9692 WOLFE RD, CALEDONIA, MS 39740
(662) 356-0320
(662) 356-0322
Mailing address
9692 WOLFE RD, CALEDONIA, MS 39740-9223
(662) 356-0320
(662) 356-0322
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
15421
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07757360
—
MS
01
—
512I110141
MEDICARE PTAN
MS
Enumeration date
07/31/2013
Last updated
07/31/2013
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