Provider Demographics
NPI:1760429682
Name:REGIONAL MEDICAL SUPPORT CENTER, INC
Entity Type:Organization
Organization Name:REGIONAL MEDICAL SUPPORT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-485-2485
Mailing Address - Street 1:PO BOX 5107
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5107
Mailing Address - Country:US
Mailing Address - Phone:601-485-2485
Mailing Address - Fax:601-483-8851
Practice Address - Street 1:2115 13TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4045
Practice Address - Country:US
Practice Address - Phone:601-485-2485
Practice Address - Fax:601-483-8851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118911Medicaid
MS00118911Medicaid