Provider Demographics
NPI:1114264264
Name:MEDICAL FOUNDATION OF CENTRAL MS
Entity Type:Organization
Organization Name:MEDICAL FOUNDATION OF CENTRAL MS
Other - Org Name:BAPTIST MEDICAL CLINIC-BRANDON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT BAPTIST MEDICAL CLINICS
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-292-4261
Mailing Address - Street 1:1490 W GOVERNMENT ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-3024
Mailing Address - Country:US
Mailing Address - Phone:601-825-1936
Mailing Address - Fax:601-825-1937
Practice Address - Street 1:1490 W GOVERNMENT ST
Practice Address - Street 2:SUITE 10
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-3024
Practice Address - Country:US
Practice Address - Phone:601-825-1936
Practice Address - Fax:601-825-1937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty