Organization
MEDICAL FOUNDATION OF SOUTH MS
Active
Other names
Bay Plaza Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY ROBINSON (ADMINISTRATOR)
(228) 865-1453
Entity
Organization
Contact information
Practice address
618 BLUE MEADOW RD, SUITE 20, BAY ST LOUIS, MS 39520-2834
(228) 463-0824
(228) 463-0827
Mailing address
1612 31ST AVE, GULFPORT, MS 39501-2750
(228) 865-1453
(228) 865-1451
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02976571
—
MS
Enumeration date
06/21/2006
Last updated
05/23/2008
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