Provider Demographics
NPI:1992166094
Name:MED OPTIONS LLC.
Entity type:Organization
Organization Name:MED OPTIONS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:601-466-0825
Mailing Address - Street 1:5266 OLD HIGHWAY 11
Mailing Address - Street 2:STE 70 PMB 104
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7817
Mailing Address - Country:US
Mailing Address - Phone:601-466-0825
Mailing Address - Fax:
Practice Address - Street 1:5266 OLD HIGHWAY 11
Practice Address - Street 2:STE 70 PMB 104
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7817
Practice Address - Country:US
Practice Address - Phone:601-466-0825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19209207R00000X
MSR865509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02902324Medicaid
MS1861801888OtherNPI
MS363724YJ9FMedicare PIN