Provider Demographics
NPI:1972857548
Name:CSC MEDICAL, LLC
Entity Type:Organization
Organization Name:CSC MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COCKRELL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP,BC
Authorized Official - Phone:601-259-7345
Mailing Address - Street 1:1126 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-5952
Mailing Address - Country:US
Mailing Address - Phone:601-250-0139
Mailing Address - Fax:601-250-0139
Practice Address - Street 1:1126 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-5952
Practice Address - Country:US
Practice Address - Phone:601-250-0139
Practice Address - Fax:601-250-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR747936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1134163512OtherNATIONAL PROVIDER IDENTIFICATION