Provider Demographics
NPI:1780494534
Name:MISSISSIPPI NEUROLOGICAL INSTITUTE LLC
Entity type:Organization
Organization Name:MISSISSIPPI NEUROLOGICAL INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HELVESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-345-4525
Mailing Address - Street 1:1190 N STATE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2413
Mailing Address - Country:US
Mailing Address - Phone:601-345-4525
Mailing Address - Fax:601-345-4535
Practice Address - Street 1:1190 N STATE ST STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2413
Practice Address - Country:US
Practice Address - Phone:601-345-4525
Practice Address - Fax:601-345-4535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty