Provider Demographics
NPI:1972694818
Name:WELCH, IRMA H (MD)
Entity type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:H
Last Name:WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-4778
Mailing Address - Fax:601-984-5420
Practice Address - Street 1:2466 FLOWOOD DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9019
Practice Address - Country:US
Practice Address - Phone:601-815-5700
Practice Address - Fax:601-815-5795
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01245307OtherRAILROAD MEDICARE
MS0116486Medicaid
MSP00462358OtherRAILROAD MEDICARE - UP
MS0116486Medicaid
MSP01245307OtherRAILROAD MEDICARE
MSB66195Medicare UPIN
MS080002646Medicare ID - Type Unspecified
MS302I088821Medicare PIN