Provider Demographics
NPI:1609934272
Name:E D MEDICAL CARE
Entity Type:Organization
Organization Name:E D MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-429-8802
Mailing Address - Street 1:2007 OAK TREE CV
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-1198
Mailing Address - Country:US
Mailing Address - Phone:662-429-8802
Mailing Address - Fax:662-429-8698
Practice Address - Street 1:2007 OAK TREE CV
Practice Address - Street 2:SUITE 101
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-1198
Practice Address - Country:US
Practice Address - Phone:662-429-8802
Practice Address - Fax:662-429-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM14539305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02403537Medicaid
MSP00175855OtherRAILROAD MEDICARE
MS0120120Medicaid
MSDC5472OtherCORP.GROUP
MS1003829680OtherNPI
MS0120120Medicaid
MSP00175855OtherRAILROAD MEDICARE