Basic Information
| Provider Information | |||||||||
| NPI: | 1093286544 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST ENDOCRINE AND METABOLISM PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 N STATE ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392021689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019441717 | ||||||||
| FaxNumber: | 6019449780 | ||||||||
| Practice Location | |||||||||
| Address1: | 3829 GREENTREE PL | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392116737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019441717 | ||||||||
| FaxNumber: | 6019449780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2018 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | EAST | ||||||||
| AuthorizedOfficialFirstName: | HONEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER / MD | ||||||||
| AuthorizedOfficialTelephone: | 6019441717 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 00121948 | 05 | MS | MEDICAID |