Provider Demographics
NPI:1619088838
Name:CANTONS PHYSICIAN GROUP
Entity Type:Organization
Organization Name:CANTONS PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-859-8992
Mailing Address - Street 1:1883 HIGHWAY 43 SOUTH
Mailing Address - Street 2:SUITE D
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046
Mailing Address - Country:US
Mailing Address - Phone:601-859-8992
Mailing Address - Fax:601-855-5265
Practice Address - Street 1:1883 HIGHWAY 43 SOUTH
Practice Address - Street 2:SUITE D
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046
Practice Address - Country:US
Practice Address - Phone:601-859-8992
Practice Address - Fax:601-855-5265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014799Medicaid
258936Medicare ID - Type Unspecified