Provider Demographics
NPI:1215058094
Name:LANDMARK INTERNAL MEDICINE
Entity type:Organization
Organization Name:LANDMARK INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-536-2500
Mailing Address - Street 1:7615 CLARINGTON CV
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5647
Mailing Address - Country:US
Mailing Address - Phone:332-536-2500
Mailing Address - Fax:662-536-2505
Practice Address - Street 1:7615 CLARINGTON CV
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5647
Practice Address - Country:US
Practice Address - Phone:332-536-2500
Practice Address - Fax:662-536-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06326035Medicaid
TN3718595Medicaid
DA1878Medicare ID - Type UnspecifiedTRAVELERS MEDICARE GROUP
TN3718595Medicare ID - Type UnspecifiedGROUP NUMBER
TN3718595Medicaid