Provider Demographics
NPI:1598421240
Name:QUITMAN PHYSICIAN GROUP
Entity Type:Organization
Organization Name:QUITMAN PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:662-934-3900
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:MARKS
Mailing Address - State:MS
Mailing Address - Zip Code:38646-0803
Mailing Address - Country:US
Mailing Address - Phone:662-934-3900
Mailing Address - Fax:
Practice Address - Street 1:340 GETWELL ST
Practice Address - Street 2:
Practice Address - City:MARKS
Practice Address - State:MS
Practice Address - Zip Code:38646-9785
Practice Address - Country:US
Practice Address - Phone:662-388-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access