Provider Demographics
NPI:1568709574
Name:MEDICAL FOUNDATION OF CENTRAL MS
Entity Type:Organization
Organization Name:MEDICAL FOUNDATION OF CENTRAL MS
Other - Org Name:BAPTIST PEDIATRIC-GENERAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT BAPTIST MEDICAL CLINICS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-292-4261
Mailing Address - Street 1:501 MARSHALL ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1651
Mailing Address - Country:US
Mailing Address - Phone:601-948-1411
Mailing Address - Fax:601-944-9780
Practice Address - Street 1:501 MARSHALL ST
Practice Address - Street 2:SUITE 500
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1651
Practice Address - Country:US
Practice Address - Phone:601-948-1411
Practice Address - Fax:601-944-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Multi-Specialty