Basic Information
| Provider Information | |||||||||
| NPI: | 1306165717 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATCHEZ MEDICAL FOUNDATION INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 SGT. S. PRENTISS DRIVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | NATCHEZ | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014423701 | ||||||||
| FaxNumber: | 6014424785 | ||||||||
| Practice Location | |||||||||
| Address1: | 46 SGT. S. PRENTISS DRIVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | NATCHEZ | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014453525 | ||||||||
| FaxNumber: | 6014424785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2010 | ||||||||
| LastUpdateDate: | 01/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | MOCK | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6014432722 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 2086S0129X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 207VX0201X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
No ID Information.