Provider Demographics
NPI:1215478730
Name:MEDICAL FOUNDATION OF CENTRAL MS INC
Entity type:Organization
Organization Name:MEDICAL FOUNDATION OF CENTRAL MS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
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 1:1201 HIGHWAY 49 S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-9425
Mailing Address - Country:US
Mailing Address - Phone:601-973-1576
Mailing Address - Fax:601-932-0056
Practice Address - Street 1:1201 HIGHWAY 49 S
Practice Address - Street 2:SUITE 1
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-9425
Practice Address - Country:US
Practice Address - Phone:601-973-1576
Practice Address - Fax:601-932-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty