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Organization

MEDSERVE, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TODD L FULCHER MD, CMD (PHYSICIAN, OWNER)
(601) 206-0901
Entity
Organization

Contact information

Practice address
MANHATTAN NURSING AND REHABILITATION CENTER, 4540 MANHATTAN RD, JACKSON, MS 39206
(601) 206-0901
(888) 240-6288
Mailing address
200 AMITY LN, BRANDON, MS 39047
(601) 206-0901
(888) 240-6288

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12503
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
05675311
MS
Enumeration date
04/19/2011
Last updated
01/13/2022
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