Provider Demographics
NPI:1982811097
Name:MISSISSIPPI PAIN MANAGEMENT
Entity Type:Organization
Organization Name:MISSISSIPPI PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-932-0238
Mailing Address - Street 1:1 LAYFAIR DR
Mailing Address - Street 2:STE 400
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9717
Mailing Address - Country:US
Mailing Address - Phone:601-932-0238
Mailing Address - Fax:601-932-4391
Practice Address - Street 1:1 LAYFAIR DR
Practice Address - Street 2:STE 400
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39232-9717
Practice Address - Country:US
Practice Address - Phone:601-932-0238
Practice Address - Fax:601-932-4391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9016049Medicaid
MS9016049Medicaid