Provider Demographics
NPI:1912459223
Name:MEDICAL FOUNDATION OF CENTRAL MS INC.
Entity Type:Organization
Organization Name:MEDICAL FOUNDATION OF CENTRAL MS INC.
Other - Org Name:BAPTIST HEART CLEVELAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-944-1717
Mailing Address - Street 1:903 E SUNFLOWER RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2835
Mailing Address - Country:US
Mailing Address - Phone:601-969-6404
Mailing Address - Fax:601-944-9780
Practice Address - Street 1:903 E SUNFLOWER RD
Practice Address - Street 2:SUITE 500
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2835
Practice Address - Country:US
Practice Address - Phone:601-969-6404
Practice Address - Fax:601-944-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty