Provider Demographics
NPI:1508020603
Name:THE STRONG HEART CLINIC, PLLC
Entity Type:Organization
Organization Name:THE STRONG HEART CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-281-1115
Mailing Address - Street 1:1300 ACCESS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5204
Mailing Address - Country:US
Mailing Address - Phone:662-281-1115
Mailing Address - Fax:662-281-1113
Practice Address - Street 1:1300 ACCESS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5204
Practice Address - Country:US
Practice Address - Phone:662-281-1115
Practice Address - Fax:662-281-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS192853207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSH61713Medicare UPIN