Organization
CSC MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA COCKRELL FNP,BC (MEMBER)
(601) 259-7345
Entity
Organization
Contact information
Practice address
1126 COUNTRY CLUB RD, MCCOMB, MS 39648-5952
(601) 250-0139
(601) 250-0139
Mailing address
1126 COUNTRY CLUB RD, MCCOMB, MS 39648-5952
(601) 250-0139
(601) 250-0139
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R747936
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134163512
NATIONAL PROVIDER IDENTIFICATION
MS
Enumeration date
11/05/2012
Last updated
02/27/2014
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