Organization
MISSISSIPPI UROLOGY CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY KEMPF POOLE RN, FACHE (CHIEF ADMINISTRATIVE OFFICER)
(601) 985-3169
Entity
Organization
Contact information
Practice address
501 MARHSALL ST, SUITE 301, JACKSON, MS 39202
(601) 353-9900
(601) 985-3199
Mailing address
501 MARHSALL ST, SUITE 301, JACKSON, MS 39202
(601) 353-9900
(601) 985-3199
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD5655
MEDICARE RR
MS
Enumeration date
07/05/2006
Last updated
10/11/2018
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