Provider Demographics
NPI:1720231509
Name:CORINTH LASER CENTER INC
Entity Type:Organization
Organization Name:CORINTH LASER CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-287-1516
Mailing Address - Street 1:PO BOX 2485
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-2485
Mailing Address - Country:US
Mailing Address - Phone:662-287-1516
Mailing Address - Fax:662-287-1517
Practice Address - Street 1:615 N CASS ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-4928
Practice Address - Country:US
Practice Address - Phone:662-287-1516
Practice Address - Fax:662-287-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty