| NPI | 1134142284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOWARD NELSON VP Physician Services 662-293-7618 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 208600000X Surgery (Licence: MS 05438) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2019-01-25 |