Provider Demographics
NPI:1215572581
Name:SPECTRUM ACADEMY
Entity Type:Organization
Organization Name:SPECTRUM ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-982-7827
Mailing Address - Street 1:PO BOX 12347
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236-2347
Mailing Address - Country:US
Mailing Address - Phone:601-982-7827
Mailing Address - Fax:
Practice Address - Street 1:2510 LAKELAND TER
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4702
Practice Address - Country:US
Practice Address - Phone:601-982-7827
Practice Address - Fax:601-822-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center