Provider Demographics
NPI:1336749274
Name:MEDPLUS STARKVILLE LLC
Entity Type:Organization
Organization Name:MEDPLUS STARKVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-320-7800
Mailing Address - Street 1:1207 HWY 182 W
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-9013
Mailing Address - Country:US
Mailing Address - Phone:662-320-7800
Mailing Address - Fax:662-269-6346
Practice Address - Street 1:1207 HWY 182 W
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9013
Practice Address - Country:US
Practice Address - Phone:662-320-7800
Practice Address - Fax:662-269-6346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care