Provider Demographics
NPI:1104004910
Name:SOUTHWEST MISSISSIPPI EMERGENCY PHYSICIANS, LTD
Entity Type:Organization
Organization Name:SOUTHWEST MISSISSIPPI EMERGENCY PHYSICIANS, LTD
Other - Org Name:HENRY LEWIS, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-657-4562
Mailing Address - Street 1:3549 LOWER CENTREVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MS
Mailing Address - Zip Code:39645-8294
Mailing Address - Country:US
Mailing Address - Phone:601-657-4562
Mailing Address - Fax:601-657-4685
Practice Address - Street 1:3549 LOWER CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MS
Practice Address - Zip Code:39645-8294
Practice Address - Country:US
Practice Address - Phone:601-657-4562
Practice Address - Fax:601-657-4685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04834174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116617Medicaid
MS00116617Medicaid