Provider Demographics
NPI:1760905509
Name:MEDICAL FOUNDATION OF CENTRAL MS INC.
Entity Type:Organization
Organization Name:MEDICAL FOUNDATION OF CENTRAL MS INC.
Other - Org Name:BAPTIST MEDICAL CLINIC EAR NOSE AND THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT BAPTIST MEDICAL CLINICS
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-292-4261
Mailing Address - Street 1:1600 N STATE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1689
Mailing Address - Country:US
Mailing Address - Phone:601-944-1717
Mailing Address - Fax:601-944-9780
Practice Address - Street 1:401 BAPTIST DR STE 206
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-2011
Practice Address - Country:US
Practice Address - Phone:601-973-1583
Practice Address - Fax:601-973-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty