Provider Demographics
NPI:1891022547
Name:MEDICAL FOUNDATION OF CENTRAL MISSISSIPPI
Entity Type:Organization
Organization Name:MEDICAL FOUNDATION OF CENTRAL MISSISSIPPI
Other - Org Name:BAPTIST MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR CLINIC OPERATIONS
Authorized Official - Prefix:MRS
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 1:1151 N STATE ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2407
Mailing Address - Country:US
Mailing Address - Phone:601-292-4261
Mailing Address - Fax:601-292-4262
Practice Address - Street 1:329 HIGHWAY 12 WEST
Practice Address - Street 2:
Practice Address - City:KOSCUISKO
Practice Address - State:MS
Practice Address - Zip Code:39090
Practice Address - Country:US
Practice Address - Phone:601-292-4261
Practice Address - Fax:601-292-4262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL FOUNDATION OF CENTRAL MISSISSIPPI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty