Provider Demographics
NPI:1407121338
Name:JFMC ELLISVILLE, LLC
Entity Type:Organization
Organization Name:JFMC ELLISVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-719-0092
Mailing Address - Street 1:602 HILL ST
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39437-2414
Mailing Address - Country:US
Mailing Address - Phone:601-719-0092
Mailing Address - Fax:601-719-0473
Practice Address - Street 1:602 HILL ST
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39437-2414
Practice Address - Country:US
Practice Address - Phone:601-719-0092
Practice Address - Fax:601-719-0473
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JONES FAMILY MEDICINE CLINIC, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-10
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care