Organization
RANKIN PRIMARY CARE CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS L ELLINGSON MD (OWNER)
(601) 824-1491
Entity
Organization
Contact information
Practice address
103 SERVICE DR, BRANDON, MS 39042-2401
(601) 824-1491
(601) 825-9504
Mailing address
PO BOX 1959, BRANDON, MS 39043-1959
(601) 824-1491
(601) 825-9504
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16492
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015199
—
MS
Enumeration date
04/08/2008
Last updated
04/08/2008
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