Provider Demographics
NPI:1487716528
Name:PHYSICIAN HOSPICE CARE LLC
Entity type:Organization
Organization Name:PHYSICIAN HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FISCAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:601-906-1011
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-0173
Mailing Address - Country:US
Mailing Address - Phone:601-906-1011
Mailing Address - Fax:601-992-8138
Practice Address - Street 1:256 DOGWOOD BLVD
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8602
Practice Address - Country:US
Practice Address - Phone:601-906-1011
Practice Address - Fax:601-992-8138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based