Provider Demographics
NPI:1508847690
Name:PLASTIC SURGICAL CENTER OF MISSISSIPPI
Entity Type:Organization
Organization Name:PLASTIC SURGICAL CENTER OF MISSISSIPPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-939-9999
Mailing Address - Street 1:2550 FLOWOOD DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9304
Mailing Address - Country:US
Mailing Address - Phone:601-939-5544
Mailing Address - Fax:601-939-8874
Practice Address - Street 1:2550 FLOWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9304
Practice Address - Country:US
Practice Address - Phone:601-939-5544
Practice Address - Fax:601-939-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0734275Medicaid
MS0734275Medicaid