Integrated Medical And Wellness Clinic Of Mississippi LLC
Family Medicine in Ridgeland, MS. Organization (NPI-2).
NPI number1104580943
StatusActive
Last updated in NPPESOct 29, 2021
Details
- NPI
- 1104580943
- Entity type
- Organization (NPI-2)
- Legal business name
- Integrated Medical And Wellness Clinic Of Mississippi LLC
- Organization subpart
- No
- Enumeration date
- Oct 27, 2021
- Certification date
- Oct 29, 2021
- Last updated
- Oct 29, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Practice location
212 Draperton CtRidgeland, MS 39157-3905
Phone 769-300-9040 · Fax 769-300-9055
Mailing address
2556 Marcia CtBiloxi, MS 39531-2352
Phone 228-248-0561 · Fax 228-248-0562
Authorized official
David F. Rowe
Owner, Authorized Official
2282480561
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