Provider Demographics
NPI:1710553052
Name:MCAFEE SAFETY ANALYSIS
Entity Type:Organization
Organization Name:MCAFEE SAFETY ANALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BRIDGEWATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-812-6252
Mailing Address - Street 1:875 NORTHPARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5223
Mailing Address - Country:US
Mailing Address - Phone:601-812-6252
Mailing Address - Fax:
Practice Address - Street 1:875 NORTHPARK DR STE 200
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5223
Practice Address - Country:US
Practice Address - Phone:601-812-6252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care