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Starkville Pediatric Extended Care Llc

NPI Registration Record

Provider / OrganizationNPIDate Certified
STARKVILLE PEDIATRIC EXTENDED CARE LLC17802937872020-07-26
Entity TypeOrganization
Provider OrganizationSTARKVILLE PEDIATRIC EXTENDED CARE LLC
Practice Office Address9771 MS HIGHWAY 25
STARKVILLE, MS US
Practice Office Telephone2512321518
Mailing Address8178 SOLDIER CT
DAPHNE, AL 365266135 US
Business Telephone2512321518
Authorized OfficialMARK HAMMOND, OWNER
2512321518
HPT Codes
CodeLicense NoState
261QM3000X PRIMARY
OPI Codes
Governmental Registrations [CAGE/NCAGE/DUNS]

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