1013213594 NPI number — RELIANT, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013213594 NPI number — RELIANT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIANT, INC.
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:
1013213594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 SUMMIT GRV
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39047-7384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-906-9052
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3825 HIGHWAY 80 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39208-4232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
769-777-4400
Provider Business Practice Location Address Fax Number:
769-777-4401
Provider Enumeration Date:
02/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BELL
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
ADAM
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
601-906-9052

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02823259 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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