Provider Demographics
NPI:1811129323
Name:DCA MISSISSIPPI LLC
Entity type:Organization
Organization Name:DCA MISSISSIPPI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-610-2067
Mailing Address - Street 1:3322 W END AVE
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1031
Mailing Address - Country:US
Mailing Address - Phone:615-515-9880
Mailing Address - Fax:615-515-9891
Practice Address - Street 1:3322 W END AVE
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1031
Practice Address - Country:US
Practice Address - Phone:615-515-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIABETES CARE GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-17
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04982860Medicaid
MS04982860Medicaid