Provider Demographics
NPI:1841413432
Name:MEDICAL FOUNDATION OF CENTRAL MISSISSIPPI, INC
Entity Type:Organization
Organization Name:MEDICAL FOUNDATION OF CENTRAL MISSISSIPPI, INC
Other - Org Name:JACKSON NEUROSURGERY & SPINE ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINIC ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-292-4261
Mailing Address - Street 1:1200 N STATE ST
Mailing Address - Street 2:SUITE 440
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2001
Mailing Address - Country:US
Mailing Address - Phone:601-969-5230
Mailing Address - Fax:601-969-5233
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:SUITE 440
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2001
Practice Address - Country:US
Practice Address - Phone:601-969-5230
Practice Address - Fax:601-969-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02783Medicaid
MSC02783Medicare ID - Type UnspecifiedMCARE GRP #