Provider Demographics
NPI:1093988602
Name:QUINCY M BENNETT
Entity Type:Organization
Organization Name:QUINCY M BENNETT
Other - Org Name:CENTRAL MS SPEECH & HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUINCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-212-5310
Mailing Address - Street 1:109 BROOKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4034
Mailing Address - Country:US
Mailing Address - Phone:601-212-5310
Mailing Address - Fax:
Practice Address - Street 1:109 BROOKFIELD DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4034
Practice Address - Country:US
Practice Address - Phone:601-212-5310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech