Provider Demographics
NPI:1083728836
Name:L.H. BRANDON M.D,.P.A
Entity Type:Organization
Organization Name:L.H. BRANDON M.D,.P.A
Other - Org Name:THE FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-323-3162
Mailing Address - Street 1:501 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2158
Mailing Address - Country:US
Mailing Address - Phone:662-323-3162
Mailing Address - Fax:662-323-1711
Practice Address - Street 1:501 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2158
Practice Address - Country:US
Practice Address - Phone:662-323-3162
Practice Address - Fax:662-323-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015316Medicaid
MSC00904Medicare PIN