Provider Demographics
NPI:1972189330
Name:RELIAS HOSPITALIST MEDICINE SPECIALISTS OF PONTOTOC LLC
Entity Type:Organization
Organization Name:RELIAS HOSPITALIST MEDICINE SPECIALISTS OF PONTOTOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-635-8383
Mailing Address - Street 1:PO BOX 32095
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28232-2095
Mailing Address - Country:US
Mailing Address - Phone:662-432-4106
Mailing Address - Fax:781-276-6411
Practice Address - Street 1:176 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-3311
Practice Address - Country:US
Practice Address - Phone:662-489-5510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty