Organization
MEDICAL FOUNDATION OF SOUTH MS
Active
Organization
MEDICAL FOUNDATION OF SOUTH MS
Active
Other names
Medical Foundation of South MS Lab
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY ROBINSON (ADMINISTRATOR)
(228) 865-1453
Entity
Organization
Contact information
Practice address
1110 BROAD AVE, SUITE 700, GULFPORT, MS 39501-8907
(228) 864-4151
Mailing address
1612 31ST AVE, GULFPORT, MS 39501-2750
(228) 865-1453
(228) 865-1451
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119065
—
MS
Enumeration date
03/27/2007
Last updated
06/13/2008
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up