Organization
MS STATE DEPT OF HELTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK PHILLIPS (CLAMS ADJUSTER)
(601) 576-7566
Entity
Organization
Contact information
Practice address
3128 8TH ST, MERIDIAN, MS 39301-4753
(601) 482-3171
Mailing address
769 CRANE RD, CARTHAGE, MS 39051-6110
(601) 267-5027
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
R505307
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124030
—
MS
Enumeration date
10/16/2006
Last updated
08/22/2020
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