1346370921 NPI number — MUSCLE AND NERVE PA

Table of content: (NPI 1346370921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346370921 NPI number — MUSCLE AND NERVE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUSCLE AND NERVE PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346370921
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
971 LAKELAND DRIVE
Provider Second Line Business Mailing Address:
SUITE 560
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-982-9826
Provider Business Mailing Address Fax Number:
601-982-9535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
971 LAKELAND DRIVE
Provider Second Line Business Practice Location Address:
SUITE 560
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-982-9826
Provider Business Practice Location Address Fax Number:
601-982-9826
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
RATHER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
601-982-9826

Provider Taxonomy Codes

  • Taxonomy code: 2084N0600X , with the licence number:  18286 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 426159735B . This is a "BCBS OF MS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 0530055 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06772854 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 169058500 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: DC2890 . This is a "GROUP RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00159488 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09014965 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130019995 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 409393032 . This is a "BCBS OF MS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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