Provider Demographics
NPI:1003098096
Name:MEDICAL FOUNDATION OF CENTRAL MISSISSIPPI, INC.
Entity Type:Organization
Organization Name:MEDICAL FOUNDATION OF CENTRAL MISSISSIPPI, INC.
Other - Org Name:BAPTIST NEUROLOGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINIC ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-292-4261
Mailing Address - Street 1:PO BOX 2153
Mailing Address - Street 2:DEPT 1947
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-0001
Mailing Address - Country:US
Mailing Address - Phone:601-355-3353
Mailing Address - Fax:601-355-3365
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:SUITE 420
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2001
Practice Address - Country:US
Practice Address - Phone:601-355-3353
Practice Address - Fax:601-355-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01627892Medicaid
MSC02783OtherMEDICARE GROUP NUMBER
DA0407OtherRR MEDICARE
MSC02783OtherMEDICARE GROUP NUMBER