| NPI | 1982009031 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOWARD NELSON VP Physaician Services 662-293-7618 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2086S0129X |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2021-05-14 |