Provider Demographics
NPI:1487432852
Name:MISSISSIPPI UROLOGY CLINIC, PLLC
Entity type:Organization
Organization Name:MISSISSIPPI UROLOGY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-353-9900
Mailing Address - Street 1:501 MARSHALL ST STE 301
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1687
Mailing Address - Country:US
Mailing Address - Phone:601-353-9900
Mailing Address - Fax:601-353-3654
Practice Address - Street 1:1040 RIVER OAKS DR STE 202
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9534
Practice Address - Country:US
Practice Address - Phone:601-353-9900
Practice Address - Fax:601-414-5381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site