Provider Demographics
NPI:1386472652
Name:ALEDADE CARE SOLUTIONS OF MISSISSIPPI, LLC
Entity type:Organization
Organization Name:ALEDADE CARE SOLUTIONS OF MISSISSIPPI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-803-7979
Mailing Address - Street 1:4780 I 55 N STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5583
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4550 MONTGOMERY AVE
Practice Address - Street 2:STE 950N
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3339
Practice Address - Country:US
Practice Address - Phone:202-803-7979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALEDADE CARE SOLUTIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty