Provider Demographics
NPI:1427063957
Name:MISSISSIPPI FAMILY DOCTORS
Entity type:Organization
Organization Name:MISSISSIPPI FAMILY DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:KROOSS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:601-932-3191
Mailing Address - Street 1:187 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-4042
Mailing Address - Country:US
Mailing Address - Phone:601-932-3191
Mailing Address - Fax:601-936-7193
Practice Address - Street 1:187 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4042
Practice Address - Country:US
Practice Address - Phone:601-939-8921
Practice Address - Fax:601-932-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013009Medicaid
MS09014761Medicaid
MSC00798OtherMEDICARE GROUP NUMBER
C00334OtherMEDICARE GROUP NUMBER
MS09013030Medicaid
MSCA8444OtherRAILROAD MEDICARE
MSCC4844OtherRAILROAD MEDICARE