| NPI | 1497007207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILLY J WILLIS Assistant Administrator 662-363-2001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MS none required) |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2012-10-04 |