Organization
JPB PATHOLOGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHEILA FULLENWIDER (OWNER)
(662) 397-0913
Entity
Organization
Contact information
Practice address
1100 BELK BLVD, OXFORD, MS 38655-5242
(800) 362-0858
(662) 534-7188
Mailing address
PO BOX 428, OXFORD, MS 38655-0428
(662) 232-8121
(662) 236-5236
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
25D0859785
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02271856
—
MS
01
—
429087482
BLUE CROSS
MS
01
—
DO6485
RAILROAD MEDICARE
—
Enumeration date
11/17/2005
Last updated
04/04/2023
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