Provider Demographics
NPI:1285126227
Name:MEDPLUS FULTON , LLC
Entity type:Organization
Organization Name:MEDPLUS FULTON , LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-841-0002
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 1:407 INTERCHANGE DRIVE
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843
Practice Address - Country:US
Practice Address - Phone:662-841-0002
Practice Address - Fax:662-269-6346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies