Provider Demographics
NPI:1275713471
Name:MISSISSIPPI ARTHRITIS CLINIC PLLC
Entity Type:Organization
Organization Name:MISSISSIPPI ARTHRITIS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-362-6900
Mailing Address - Street 1:185 MEDICAL PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-1248
Mailing Address - Country:US
Mailing Address - Phone:601-362-6900
Mailing Address - Fax:601-362-6111
Practice Address - Street 1:185 MEDICAL PKWY STE 201
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-1248
Practice Address - Country:US
Practice Address - Phone:601-540-6850
Practice Address - Fax:601-362-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00650765Medicaid