Organization
PREMIER MEDICAL GROUP OF MISSISSIPPI LLC
Active
Other names
Jackson Medical Clinic LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES C BETHEA (CEO)
(601) 352-2273
Entity
Organization
Contact information
Practice address
501 MARSHALL ST, SUITE 208, JACKSON, MS 39202-1651
(601) 352-2273
(601) 353-4414
Mailing address
PO BOX 23996, JACKSON, MS 39225-3996
(601) 206-6113
(601) 206-6052
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014760
—
MS
01
—
CD1075
RAILROAD MEDICARE
MS
Enumeration date
05/05/2006
Last updated
02/16/2009
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