Organization
CARDIOVASCULAR PHYSICIANS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL MANSOUR M.D. (OWNER)
(662) 378-9191
Entity
Organization
Contact information
Practice address
1315 E UNION ST, GREENVILLE, MS 38703-3245
(662) 378-9191
(662) 378-5353
Mailing address
PO BOX 5219, GREENVILLE, MS 38704-5219
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014784
—
MS
01
—
134988002
MEDICAID OF ARKANSAS
—
01
—
CN7044
MEDICARE RAILROAD
MS
Enumeration date
08/27/2007
Last updated
10/20/2010
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