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
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