Organization
PREMIER MEDICAL GROUP OF MISSISSIPPI LLC
Active
Other names
Kosciusko Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACKEY D TURNER M.D. (MEDICAL DIRECTOR)
(662) 289-1800
Entity
Organization
Contact information
Practice address
332 HIGHWAY 12 W, KOSCIUSKO, MS 39090-3209
(662) 289-1800
Mailing address
PO BOX 23996, JACKSON, MS 39225-3996
(601) 206-6100
(601) 206-6052
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015162
—
MS
01
—
CG1185
RAILROAD MEDICARE
MS
Enumeration date
02/13/2007
Last updated
10/02/2008
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