Provider Demographics
NPI:1154916872
Name:MEDPLUS NEW ALBANY LLC
Entity type:Organization
Organization Name:MEDPLUS NEW ALBANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-222-2273
Mailing Address - Street 1:874 BARNES CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-0909
Mailing Address - Country:US
Mailing Address - Phone:662-841-0002
Mailing Address - Fax:662-269-6346
Practice Address - Street 1:180 PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3127
Practice Address - Country:US
Practice Address - Phone:662-222-2219
Practice Address - Fax:662-510-0216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies