Organization
MOSS POINT FAMILY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM SIDNEY ROBERT ROSS MD (OWNER)
(228) 355-0719
Entity
Organization
Contact information
Practice address
5430 GRIFFIN ST, MOSS POINT, MS 39563-2003
(228) 355-0719
(228) 475-4039
Mailing address
5430 GRIFFIN ST, MOSS POINT, MS 39563-2003
(228) 355-0719
(228) 475-4039
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
12739
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0115091
—
MS
05
—
01903811
—
MS
01
—
1710955869
PA GRAY'S NPI
MS
01
—
1972617884
PERSONAL NPI NUMBER FOR M
MS
01
—
296723832
BCBS
MS
01
—
DG3268
RAILROAD MEDICARE
MS
Enumeration date
05/13/2007
Last updated
05/22/2008
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