Provider Demographics
NPI:1023220944
Name:TRUSTMORE INCORPORATED
Entity Type:Organization
Organization Name:TRUSTMORE INCORPORATED
Other - Org Name:TRUSTMORE HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-946-3939
Mailing Address - Street 1:102 METROPLEX BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-9202
Mailing Address - Country:US
Mailing Address - Phone:601-502-2350
Mailing Address - Fax:601-939-1199
Practice Address - Street 1:102 METROPLEX BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-9202
Practice Address - Country:US
Practice Address - Phone:601-502-2350
Practice Address - Fax:601-939-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS068640263336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2586418OtherNCPDP PROVIDER IDENTIFICATION NUMBER