Basic Information
| Provider Information | |||||||||
| NPI: | 1902178346 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAPTIST JACKSON HEART CARDIOLOGY CLINIC-MAGEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 SIMPSON HIGHWAY 149 | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | MAGEE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391113841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019827850 | ||||||||
| FaxNumber: | 6019449780 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 N STATE ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392021689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019441717 | ||||||||
| FaxNumber: | 6019449780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2012 | ||||||||
| LastUpdateDate: | 02/01/2012 | ||||||||
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| AuthorizedOfficialLastName: | MULLINS | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6012924262 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.