Provider Demographics
NPI:1609246370
Name:MISSISSIPPI COUNTY PRIMARY CARE PHYSICIANS
Entity Type:Organization
Organization Name:MISSISSIPPI COUNTY PRIMARY CARE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LADD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-838-7311
Mailing Address - Street 1:602 W UNION AVE
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72370-3014
Mailing Address - Country:US
Mailing Address - Phone:870-563-6504
Mailing Address - Fax:
Practice Address - Street 1:602 W UNION AVE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-3014
Practice Address - Country:US
Practice Address - Phone:870-563-6504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty