Provider Demographics
NPI:1891912226
Name:JOSEPH S MESSINA JR MD
Entity Type:Organization
Organization Name:JOSEPH S MESSINA JR MD
Other - Org Name:INTERNAL MEDICINE CLINIC OF GRENADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MESSINA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:662-226-1646
Mailing Address - Street 1:1300 SUNSET DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901
Mailing Address - Country:US
Mailing Address - Phone:662-226-1646
Mailing Address - Fax:662-227-1599
Practice Address - Street 1:1300 SUNSET DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901
Practice Address - Country:US
Practice Address - Phone:662-226-1646
Practice Address - Fax:662-227-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10305174400000X
MSR713066174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08232351Medicaid
MS1518980887OtherDR NPI
MS02654890Medicaid
MS1558382358OtherNP NPI
MS1558382358OtherNP NPI
MS500001641Medicare PIN
MS02654890Medicaid
MS110001808Medicare PIN