Provider Demographics
NPI:1013594498
Name:M3 MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:M3 MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-944-1717
Mailing Address - Street 1:768 FOX RD SE
Mailing Address - Street 2:
Mailing Address - City:BOGUE CHITTO
Mailing Address - State:MS
Mailing Address - Zip Code:39629-3009
Mailing Address - Country:US
Mailing Address - Phone:601-757-6192
Mailing Address - Fax:
Practice Address - Street 1:768 FOX RD SE
Practice Address - Street 2:
Practice Address - City:BOGUE CHITTO
Practice Address - State:MS
Practice Address - Zip Code:39629-3009
Practice Address - Country:US
Practice Address - Phone:601-757-6192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty