Organization
FIRST INTERMED CORPORATION
Active
Other names
MEA Medical Clinics
Organization subpart
No
Provider details
NPI number
Authorized official
SAM SCOTT (PHYSICIAN SERVICES COORDINATOR)
(601) 898-7525
Entity
Organization
Contact information
Practice address
5606 OLD CANTON RD, JACKSON, MS 39211-4217
(601) 957-3333
(601) 957-3334
Mailing address
5606 OLD CANTON RD, JACKSON, MS 39211-4217
(601) 957-3333
(601) 957-3334
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015301
—
MS
01
—
CH0373
RAILROAD MEDICARE
MS
01
—
CH0704
RAILROAD MEDICARE
MS
01
—
CH7890
RAILROAD MEDICARE
MS
01
—
CH7891
RAILROAD MEDICARE
MS
01
—
CH7892
RAILROAD MEDICARE
MS
01
—
CH7894
RAILROAD MEDICARE
MS
01
—
CH7895
RAILROAD MEDICARE
MS
01
—
CH7896
RAILROAD MEDICARE
MS
01
—
CH7897
RAILROAD MEDICARE
MS
01
—
CH9760
RAILROAD MEDICARE
MS
Enumeration date
07/10/2006
Last updated
03/30/2011
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