Provider Demographics
NPI:1578709473
Name:DR. JERRY MCBRIDE LLC
Entity Type:Organization
Organization Name:DR. JERRY MCBRIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-862-9741
Mailing Address - Street 1:301 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-6003
Mailing Address - Country:US
Mailing Address - Phone:662-862-9741
Mailing Address - Fax:662-862-3584
Practice Address - Street 1:301 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-6003
Practice Address - Country:US
Practice Address - Phone:662-862-9741
Practice Address - Fax:662-862-3584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS425152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0767960001Medicare NSC