Provider Demographics
NPI:1639586076
Name:BAPTIST HEART
Entity Type:Organization
Organization Name:BAPTIST HEART
Other - Org Name:MEDICAL FOUNDATION OF CENTRAL MS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF BAPTIST MEDICAL CLINIC
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-292-4261
Mailing Address - Street 1:501 MARSHALL ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1651
Mailing Address - Country:US
Mailing Address - Phone:601-969-6404
Mailing Address - Fax:601-944-9780
Practice Address - Street 1:501 MARSHALL ST
Practice Address - Street 2:SUITE 104
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1651
Practice Address - Country:US
Practice Address - Phone:601-969-6404
Practice Address - Fax:601-944-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty