Provider Demographics
NPI:1508386582
Name:ELEMENTS MEDICAL GROUP OF MISSISSIPPI INC
Entity Type:Organization
Organization Name:ELEMENTS MEDICAL GROUP OF MISSISSIPPI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR RCM
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPLESDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-540-3708
Mailing Address - Street 1:PO BOX 671673
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-1673
Mailing Address - Country:US
Mailing Address - Phone:562-303-9718
Mailing Address - Fax:562-264-1219
Practice Address - Street 1:3949 HIGHWAY 43 N
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-7240
Practice Address - Country:US
Practice Address - Phone:601-829-2500
Practice Address - Fax:601-829-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7875207RA0401X
MS2084P0800X
MS862194363LF0000X
MS850823363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty