Provider Demographics
NPI:1669522942
Name:MISSISSIPPI FAMILY MEDICINE P C
Entity type:Organization
Organization Name:MISSISSIPPI FAMILY MEDICINE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-671-8555
Mailing Address - Street 1:940 MATTHEW DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2522
Mailing Address - Country:US
Mailing Address - Phone:601-671-8555
Mailing Address - Fax:601-671-0777
Practice Address - Street 1:940 MATTHEW DR
Practice Address - Street 2:SUITE 2
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2522
Practice Address - Country:US
Practice Address - Phone:601-671-8555
Practice Address - Fax:601-671-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0117444Medicaid
MS279588OtherDR. TYNES
AL009926375OtherDR. STROKLEY
MS0113843Medicaid
MSC02214OtherMEDICARE PROVIDER ID
AL00964OtherDR. STOKLEY
AL009700450OtherDR. TYNES
MS279588OtherDR. STOKLEY
CD1005OtherPALMETTOGBA - RAILROAD MEDICARE
AL073075294TYNOtherDR. TYNES
MS080003076Medicare ID - Type UnspecifiedDR. STOKLEY
MS279588OtherDR. TYNES
MS279588OtherDR. STOKLEY
MS0117444Medicaid