Provider Demographics
NPI:1427063965
Name:REGIONAL MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:REGIONAL MEDICAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRILOUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-328-9623
Mailing Address - Street 1:1503 HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2113
Mailing Address - Country:US
Mailing Address - Phone:662-328-9623
Mailing Address - Fax:662-327-7477
Practice Address - Street 1:2001 AIRPORT RD N
Practice Address - Street 2:SUITE 204
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8827
Practice Address - Country:US
Practice Address - Phone:601-936-7199
Practice Address - Fax:601-936-7193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02342OtherMEDICARE GROUP
MSCD1061OtherRAILROAD MEDICARE GROUP
MS09015057Medicaid