Provider Demographics
NPI:1619645520
Name:UCFA PHYSICIANS NETWORK GROUP OF MISSISSIPPI
Entity Type:Organization
Organization Name:UCFA PHYSICIANS NETWORK GROUP OF MISSISSIPPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING CHIEF OF PNG
Authorized Official - Prefix:
Authorized Official - First Name:THEO
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-271-9911
Mailing Address - Street 1:8930 CROSS PARK DR STE 3
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4713
Mailing Address - Country:US
Mailing Address - Phone:423-712-9911
Mailing Address - Fax:
Practice Address - Street 1:296 BEAUVOIR RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4051
Practice Address - Country:US
Practice Address - Phone:423-271-9911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty