Provider Demographics
NPI:1356693287
Name:HORACE E. GLOVER MEDICAL SERVICES
Entity type:Organization
Organization Name:HORACE E. GLOVER MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:662-316-1334
Mailing Address - Street 1:14757 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:MS
Mailing Address - Zip Code:39063-3922
Mailing Address - Country:US
Mailing Address - Phone:662-316-1334
Mailing Address - Fax:
Practice Address - Street 1:14757 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:MS
Practice Address - Zip Code:39063-3922
Practice Address - Country:US
Practice Address - Phone:662-316-1334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR856333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty