Provider Demographics
NPI:1528371119
Name:UNIVERSITY PHYSICIANS. PLLC
Entity Type:Organization
Organization Name:UNIVERSITY PHYSICIANS. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SRNA
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:COOK
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-750-5574
Mailing Address - Street 1:121 BEAUFORT CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7962
Mailing Address - Country:US
Mailing Address - Phone:601-750-5574
Mailing Address - Fax:
Practice Address - Street 1:121 BEAUFORT CIR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7962
Practice Address - Country:US
Practice Address - Phone:601-750-5574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000158639282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01003769OtherRR MEDICARE