1306067277 NPI number — PEDIATRIC ORTHOPAEDIC SPECIALISTS OF MISSISSIPPI

Table of content: CARRIE MITCHELL MCINNIS M.D. (NPI 1497011878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306067277 NPI number — PEDIATRIC ORTHOPAEDIC SPECIALISTS OF MISSISSIPPI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC ORTHOPAEDIC SPECIALISTS OF MISSISSIPPI
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:
1306067277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1190 N STATE ST
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39202-2413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-353-8066
Provider Business Mailing Address Fax Number:
601-353-8155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1190 N STATE ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39202-2413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-353-8066
Provider Business Practice Location Address Fax Number:
601-353-8155
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOBBS
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
601-353-8066

Provider Taxonomy Codes

  • Taxonomy code: 207XP3100X , 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)





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