Provider Demographics
NPI:1578016259
Name:MEDICAL FOUNDATION OF CENTRAL MS INC
Entity Type:Organization
Organization Name:MEDICAL FOUNDATION OF CENTRAL MS INC
Other - Org Name:BAPTIST JACKSON HEART CARDIOLOGY CLINIC GREENVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT BMC CLINIC
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-292-4261
Mailing Address - Street 1:1502 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-7219
Mailing Address - Country:US
Mailing Address - Phone:662-379-8192
Mailing Address - Fax:662-378-0290
Practice Address - Street 1:1502 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7219
Practice Address - Country:US
Practice Address - Phone:662-379-8192
Practice Address - Fax:662-378-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty