Provider Demographics
NPI: | 1326312786 |
---|---|
Name: | MISSISSIPPI MEDICAL RESEARCH, LLC |
Entity Type: | Organization |
Organization Name: | MISSISSIPPI MEDICAL RESEARCH, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | AHMAD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HAIDAR |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 601-749-3549 |
Mailing Address - Street 1: | 1016 SIXTH AVE STE B |
Mailing Address - Street 2: | |
Mailing Address - City: | PICAYUNE |
Mailing Address - State: | MS |
Mailing Address - Zip Code: | 39466-3861 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 601-749-3549 |
Mailing Address - Fax: | 601-749-3448 |
Practice Address - Street 1: | 1016 SIXTH AVE STE B |
Practice Address - Street 2: | |
Practice Address - City: | PICAYUNE |
Practice Address - State: | MS |
Practice Address - Zip Code: | 39466-3861 |
Practice Address - Country: | US |
Practice Address - Phone: | 601-749-3549 |
Practice Address - Fax: | 601-749-3448 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-03-02 |
Last Update Date: | 2012-03-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MS | 13678 | 261QR1100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR1100X | Ambulatory Health Care Facilities | Clinic/Center | Research |