Organization
MISSISSIPPI FAMILY DOCTORS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM F KROOSS II MD (MEDICAL DIRECTOR)
(601) 932-3191
Entity
Organization
Contact information
Practice address
187 DOCTORS DR, PEARL, MS 39208-4042
(601) 939-8921
(601) 932-5902
Mailing address
187 DOCTORS DR, PEARL, MS 39208-4042
(601) 932-3191
(601) 936-7193
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013009
—
MS
05
—
09013030
—
MS
05
—
09014761
—
MS
01
—
C00334
MEDICARE GROUP NUMBER
—
01
—
C00798
MEDICARE GROUP NUMBER
MS
01
—
CA8444
RAILROAD MEDICARE
MS
01
—
CC4844
RAILROAD MEDICARE
MS
Enumeration date
07/31/2006
Last updated
05/30/2012
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