Provider Demographics
NPI:1164682464
Name:HARISH M. MADNANI M.D.P.C
Entity Type:Organization
Organization Name:HARISH M. MADNANI M.D.P.C
Other - Org Name:HARISH M. MADNANI
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARISH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MADNANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-876-6006
Mailing Address - Street 1:251 HOSPITAL DR
Mailing Address - Street 2:B
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-2025
Mailing Address - Country:US
Mailing Address - Phone:601-876-6006
Mailing Address - Fax:601-876-3603
Practice Address - Street 1:251 HOSPITAL DR
Practice Address - Street 2:B
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-2025
Practice Address - Country:US
Practice Address - Phone:601-876-6006
Practice Address - Fax:601-876-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015697Medicaid
MS09015697Medicaid