Organization
STATE OF MISSISSIPPI- UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Active
Other names
UMC Medical Mall
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM KENNEDY (ASSOCIATE ADMINISTRATOR)
(601) 984-4699
Entity
Organization
Contact information
Practice address
350 W WOODROW WILSON AVE, SUITE 479, JACKSON, MS 39213-7681
(601) 815-6350
(601) 815-6348
Mailing address
350 W WOODROW WILSON AVE, SUITE 479, JACKSON, MS 39213-7681
(601) 815-6350
(601) 815-6348
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20256
—
MS
Enumeration date
05/10/2007
Last updated
10/02/2007
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