Provider Demographics
NPI:1407968738
Name:MINOR MED CARE, P.A.
Entity Type:Organization
Organization Name:MINOR MED CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DUNCAN
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-372-1117
Mailing Address - Street 1:2860 MCDOWELL ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-4238
Mailing Address - Country:US
Mailing Address - Phone:601-372-1117
Mailing Address - Fax:601-373-3004
Practice Address - Street 1:2860 MCDOWELL ROAD EXT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-4238
Practice Address - Country:US
Practice Address - Phone:601-372-1117
Practice Address - Fax:601-373-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09740261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care