Organization
MISSISSIPPI PHS PC
Active
Parent organization
PROVIDER HEALTH SERVICES LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDER HEALTH SERVICES LLC
Authorized official
NICOLE HOWARD (CFO)
(337) 991-9276
Entity
Organization
Contact information
Practice address
405 BRIARWOOD DRIVE, SUITE 103, JACKSON, MS 39206-3029
(901) 261-4848
(901) 261-4849
Mailing address
1509 DULLES DRIVE, LAFAYETTE, LA 70506
(337) 991-9276
(337) 991-9288
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00439060
—
MS
Enumeration date
07/21/2009
Last updated
07/02/2014
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