| Internal Medicine Clinic | |
|
1110 Broad Ave Suite 700 Gulfport MS 39501-8907 | |
| (228) 864-0314 | |
| (228) 864-0425 |
| Full Name | Internal Medicine Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 1110 Broad Ave, Gulfport, Mississippi |
| Authorized Official Name and Position | Randy Robinson (ADMINISTRATOR) |
| Authorized Official Contact | 2288651453 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Internal Medicine Clinic 1612 31st Ave Gulfport MS 39501-2750 Ph: (228) 865-1453 | Internal Medicine Clinic 1110 Broad Ave Suite 700 Gulfport MS 39501-8907 Ph: (228) 864-0314 |
| NPI Number | 1245276740 |
|---|---|
| Provider Enumeration Date | 06/22/2006 |
| Last Update Date | 04/02/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245276740 | NPI | - | NPPES |
| 09014379 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
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