Provider Demographics
NPI:1821475617
Name:MEDICAL FOUNDATION OF CENTRAL MS, INC
Entity Type:Organization
Organization Name:MEDICAL FOUNDATION OF CENTRAL MS, INC
Other - Org Name:MBMC PSYCHIATRISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT BAPTIST MEDICAL CLINICS
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 1:1225 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2064
Mailing Address - Country:US
Mailing Address - Phone:601-968-1000
Mailing Address - Fax:601-944-9780
Practice Address - Street 1:1600 N STATE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1689
Practice Address - Country:US
Practice Address - Phone:601-944-1717
Practice Address - Fax:601-944-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty