Vuncannon, Larry Keith
Vuncannon, Larry Keith is an sole proprietor health care provider with primary practice located at 503 Constitution Dr , Iuka MS 38852-8201. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Vuncannon, Larry Keith can be contacted via phone (662) 424-9500.Contact Information
Primary practice address
503 Constitution Dr
Iuka MS 38852-8201
Phone: (662) 424-9500
Fax: (662) 424-9592
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | PT1052 | Mississippi |
Profile Details
| NPI number | 1609913466 |
|---|---|
| LBN Legal business name | Vuncannon, Larry Keith |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 31st, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1609913466 | NPPES |
| Mississippi | MEDICAID | 00119836 |
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