Organization
FIRST INTERMED CORPORATION
Active
Other names
MEA Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SAM SCOTT (CFO)
(601) 898-7525
Entity
Organization
Contact information
Practice address
112 SOUTH LAKE CIRCLE, CANTON, MS 39046
(601) 859-8550
(601) 859-8556
Mailing address
112 SOUTH LAKE CIRCLE, CANTON, MS 39046
(601) 859-8550
(601) 859-8556
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015301
—
MS
01
—
CH7894
RAILROAD MEDICARE
MS
Enumeration date
03/09/2007
Last updated
02/12/2008
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