Provider Demographics
NPI:1346370921
Name:MUSCLE AND NERVE PA
Entity Type:Organization
Organization Name:MUSCLE AND NERVE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:RATHER
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-982-9826
Mailing Address - Street 1:971 LAKELAND DRIVE
Mailing Address - Street 2:SUITE 560
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-982-9826
Mailing Address - Fax:601-982-9535
Practice Address - Street 1:971 LAKELAND DRIVE
Practice Address - Street 2:SUITE 560
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-982-9826
Practice Address - Fax:601-982-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS182862084N0600X
MS107702084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS426159735BOtherBCBS OF MS
0530055OtherUNITED HEALTH CARE
MS06772854Medicaid
169058500OtherUS DEPT OF LABOR
DC2890OtherGROUP RAILROAD MEDICARE
P00159488OtherRAILROAD MEDICARE
MS09014965Medicaid
130019995OtherRAILROAD MEDICARE
MS409393032OtherBCBS OF MS