Provider Demographics
NPI:1831656354
Name:BOUNDS FAMILY MEDICAL
Entity Type:Organization
Organization Name:BOUNDS FAMILY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-807-9550
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MS
Mailing Address - Zip Code:39069-0091
Mailing Address - Country:US
Mailing Address - Phone:601-809-0882
Mailing Address - Fax:
Practice Address - Street 1:821 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069-5695
Practice Address - Country:US
Practice Address - Phone:601-809-0882
Practice Address - Fax:601-809-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07583381Medicaid