Provider Demographics
NPI:1346462751
Name:DRS LENOIR AND CIRILLI PA
Entity Type:Organization
Organization Name:DRS LENOIR AND CIRILLI PA
Other - Org Name:PROFESSIONAL ASSOCIATION CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:SEC TRES DRS LENOIR AND CIRILLI PA
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CIRILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-335-3541
Mailing Address - Street 1:PO BOX 5967
Mailing Address - Street 2:1307 EAST UNION
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-5967
Mailing Address - Country:US
Mailing Address - Phone:662-335-3541
Mailing Address - Fax:662-332-0331
Practice Address - Street 1:1307 EAST UNION
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703
Practice Address - Country:US
Practice Address - Phone:662-335-3541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10254207Q00000X, 207R00000X
MS3813207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9011164Medicaid
MS9011164Medicaid
MSC00419Medicare PIN