Provider Demographics
NPI:1598082802
Name:TREE HOUSE MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:TREE HOUSE MEDICAL ASSOCIATES, LLC
Other - Org Name:TREEHOUSE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-528-9006
Mailing Address - Street 1:2201 HIGHWAY 49 STE B
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-8013
Mailing Address - Country:US
Mailing Address - Phone:601-528-9006
Mailing Address - Fax:601-528-9046
Practice Address - Street 1:2201 HIGHWAY 49 STE B
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-8013
Practice Address - Country:US
Practice Address - Phone:601-528-9006
Practice Address - Fax:601-528-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18201208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty