Provider Demographics
NPI:1346424298
Name:RS RUNNELS JR. M.D. PLLC
Entity Type:Organization
Organization Name:RS RUNNELS JR. M.D. PLLC
Other - Org Name:THE RUNNELS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RUNNELS, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-939-9778
Mailing Address - Street 1:1055 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9595
Mailing Address - Country:US
Mailing Address - Phone:601-939-9778
Mailing Address - Fax:601-939-9416
Practice Address - Street 1:1055 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9595
Practice Address - Country:US
Practice Address - Phone:601-939-9778
Practice Address - Fax:601-939-9416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13960208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC03260Medicare PIN