Provider Demographics
NPI:1265634588
Name:COX MEDICAL & WELLNESS CLINICS, P.L.L.C.
Entity Type:Organization
Organization Name:COX MEDICAL & WELLNESS CLINICS, P.L.L.C.
Other - Org Name:COX MEDICAL & WELLNSS CLINICS, P.L.L.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YUREE
Authorized Official - Middle Name:E
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:601-373-3344
Mailing Address - Street 1:2941 TERRY RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3073
Mailing Address - Country:US
Mailing Address - Phone:601-373-3344
Mailing Address - Fax:301-373-3345
Practice Address - Street 1:2941 TERRY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-3073
Practice Address - Country:US
Practice Address - Phone:601-373-3344
Practice Address - Fax:301-373-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04276246Medicaid