Basic Information
| Provider Information | |||||||||
| NPI: | 1508386582 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELEMENTS MEDICAL GROUP OF MISSISSIPPI INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 671673 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752671673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5623039718 | ||||||||
| FaxNumber: | 5622641219 | ||||||||
| Practice Location | |||||||||
| Address1: | 3949 HIGHWAY 43 N | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390477240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018292500 | ||||||||
| FaxNumber: | 6018294278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2017 | ||||||||
| LastUpdateDate: | 06/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | MAPLESDEN | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR DIRECTOR RCM | ||||||||
| AuthorizedOfficialTelephone: | 6155403708 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 363LF0000X | 862194 | MS | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0808X | 850823 | MS | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 207RA0401X | 7875 | MS | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine |
No ID Information.