Provider Demographics
NPI:1477693299
Name:ARTHRITIS, OSTEOPOROSIS TREATMENT AND RESEARCH CENTER PLLC
Entity Type:Organization
Organization Name:ARTHRITIS, OSTEOPOROSIS TREATMENT AND RESEARCH CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-420-0034
Mailing Address - Street 1:2550 FLOWOOD DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9306
Mailing Address - Country:US
Mailing Address - Phone:601-420-0034
Mailing Address - Fax:601-420-5482
Practice Address - Street 1:2550 FLOWOOD DR STE 300
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9306
Practice Address - Country:US
Practice Address - Phone:601-420-0034
Practice Address - Fax:601-420-5482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSCK7048OtherMEDICARE RAILROAD
660002223OtherMEDICARE RR PTAN
MSC03036Medicare ID - Type UnspecifiedMEDICARE GROUP #
1219630001Medicare NSC