Organization
JACKSON NEUROSURGERY CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZOE LEWIS (PRACTICE ADMINISTRATOR)
(601) 321-1504
Entity
Organization
Contact information
Practice address
1080 RIVER OAKS DR, SUITE B-103, FLOWOOD, MS 39232-9779
(601) 366-1011
(601) 932-6111
Mailing address
1080 RIVER OAKS DR, SUITE B-103, FLOWOOD, MS 39232-9779
(601) 366-1011
(601) 932-6111
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08288260
—
MS
01
—
C03059
MEDICARE GROUP
MS
01
—
CK4238
RAILROAD MEDICARE
MS
Enumeration date
10/25/2006
Last updated
10/28/2016
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