Southern Family Medicine

LBN: Southern Family Medicine
Southern Family Medicine is an health care organization with primary practice located at 603 S Holly Ave , Collins MS 39428-3801. The organization recently has only one registered license in Ambulatory Health Care Facilities / Medical Specialty, which is considered as the primary health care specialty. Southern Family Medicine can be contacted via phone (601) 765-9393, or through Beasley, Jason Gregory via phone (601) 765-9393.

Contact Information

Primary practice address
603 S Holly Ave Collins MS 39428-3801
Phone: (601) 765-9393
Fax: (601) 765-9363
Website:
Map and Directions
Authorized official contact:
Name: Beasley, Jason Gregory Doctor of Medicine (MD)
Phone: (601) 765-9393

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Medical Specialty 261QM2500X

Profile Details

NPI number 1982608691
LBN Legal business name Southern Family Medicine
DBA Doing business as
Authorized official Beasley, Jason Gregory Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jun 9th, 2005
Last updated Jan 22nd, 2019 - about 5 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 1982608691 NPPES
Mississippi MEDICAID 01588261
Mississippi Other 25D1026870

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