Organization
STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Active
Other names
Big Mouth Bass Clinic - Sanderson Tower - Level B
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY GRIMSLEY (CFO)
(601) 815-6270
Entity
Organization
Contact information
Practice address
2500 N. STATE STREET, BIG MOUTH BASS CLINIC - SANDERSON TOWER - LEVEL B, JACKSON, MS 39216-4500
(601) 984-6025
Mailing address
504 CLINTON CENTER DRIVE, CBO - SUITE 4300, CLINTON, MS 39056
(601) 496-9794
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
08/23/2022
Last updated
05/01/2024
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