Provider Demographics
NPI:1528405206
Name:ALLYMED, INC
Entity Type:Organization
Organization Name:ALLYMED, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:662-489-6522
Mailing Address - Street 1:7618 HIGHWAY 15 NORTH
Mailing Address - Street 2:
Mailing Address - City:ECRU
Mailing Address - State:MS
Mailing Address - Zip Code:38841
Mailing Address - Country:US
Mailing Address - Phone:662-489-6522
Mailing Address - Fax:662-489-0380
Practice Address - Street 1:7618 HIGHWAY 15 NORTH
Practice Address - Street 2:
Practice Address - City:ECRU
Practice Address - State:MS
Practice Address - Zip Code:38841
Practice Address - Country:US
Practice Address - Phone:662-489-6522
Practice Address - Fax:662-489-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS291350Medicare PIN