Organization
BURRELL INDEPENDENT CONTRACTING SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES LARRY BURRELL JR. NP (OWNER)
(662) 419-9150
Entity
Organization
Contact information
Practice address
1515 MUNSFORD DR, NEW ALBANY, MS 38652-7407
(662) 534-0046
Mailing address
117 OAK DR, PONTOTOC, MS 38863-1527
(662) 419-9150
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03906898
—
MS
Enumeration date
07/29/2022
Last updated
07/29/2022
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