Provider Demographics
NPI:1356671556
Name:MISSISSIPPI BRAIN AND SPINE, PLLC
Entity Type:Organization
Organization Name:MISSISSIPPI BRAIN AND SPINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ILERCIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-613-9501
Mailing Address - Street 1:1 LAYFAIR DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 LAYFAIR DR
Practice Address - Street 2:SUITE 120
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9717
Practice Address - Country:US
Practice Address - Phone:601-613-9501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty