Provider Demographics
NPI:1487852992
Name:MISSISSIPPI BREASTFEEDING MEDICINE CLINIC, PLLC
Entity Type:Organization
Organization Name:MISSISSIPPI BREASTFEEDING MEDICINE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SAENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-898-7979
Mailing Address - Street 1:PO BOX 1538
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-1538
Mailing Address - Country:US
Mailing Address - Phone:601-898-7979
Mailing Address - Fax:601-898-7989
Practice Address - Street 1:111A DEPOT DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9395
Practice Address - Country:US
Practice Address - Phone:601-898-7979
Practice Address - Fax:601-898-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09985283Medicaid
MS00115032Medicaid