Provider Demographics
NPI: | 1588369128 |
---|---|
Name: | VALUE IN PREVENTION OF MISSISSIPPI, PLLC |
Entity type: | Organization |
Organization Name: | VALUE IN PREVENTION OF MISSISSIPPI, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF MEDICAL OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANDREA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KLEMES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DO |
Authorized Official - Phone: | 561-982-4300 |
Mailing Address - Street 1: | 4950 COMMUNICATION AVE STE 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | BOCA RATON |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33431-3308 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-982-4300 |
Mailing Address - Fax: | 561-455-9215 |
Practice Address - Street 1: | 11 DOCTORS DR |
Practice Address - Street 2: | |
Practice Address - City: | OCEAN SPRINGS |
Practice Address - State: | MS |
Practice Address - Zip Code: | 39564-5709 |
Practice Address - Country: | US |
Practice Address - Phone: | 228-266-2208 |
Practice Address - Fax: | 228-875-1335 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-04-03 |
Last Update Date: | 2023-04-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty |