121 Medical Place, Inc

LBN: 121 Medical Place, Inc
121 Medical Place, Inc is an health care organization with primary practice located at 820 Mangum Ave , Mendenhall MS 39114-3025. The organization recently has only one registered license in Ambulatory Health Care Facilities / Community Health, which is considered as the primary health care specialty. 121 Medical Place, Inc can be contacted via phone (601) 906-1897, or through Leach, Shelley via phone (601) 906-1897.

Contact Information

Primary practice address
820 Mangum Ave Mendenhall MS 39114-3025
Phone: (601) 906-1897
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Leach, Shelley FNP-C
Phone: (601) 906-1897

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Community Health 261QC1500X R863242 Mississippi

Profile Details

NPI number 1588106553
LBN Legal business name 121 Medical Place, Inc
DBA Doing business as
Authorized official Leach, Shelley FNP-C
Entity Organization
Organization subpart 1 No
Enumeration date Nov 8th, 2016
Last updated Nov 8th, 2016 - about 8 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588106553 NPPES
Mississippi MEDICAID 00476391

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