East Mississippi Community College
Organization Active NPI General Practice Physician · Scooba, MS
NPI 1043780836 · NPPES record last updated Dec 5, 2018
Key facts
- NPI
- 1043780836
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- Legal business name
- EAST MISSISSIPPI COMMUNITY COLLEGE
- Practice address
- 1512 Kemper St
Scooba, MS 39358-7601 - Phone
- (972) 367-4845
- NPI assigned
- Dec 5, 2018
- Organization subpart
- No
Authorized official
- Name
- Mouzon Bass III
- Title
- Administrator/Agent
- Phone
- (972) 367-4845
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | Yes |
Addresses
Primary practice location
1512 Kemper St
Scooba, MS 39358-7601
Mailing address
5050 Spring Valley Rd
Dallas, TX 75244-3995
Other names
- EMCC Sports Medicine
Other providers in Scooba, MS
- Steven Bontrager
- Greater Meridian Health Clinic, Inc.
- Suzanne Hagar
- Qyhdijha Ivy
- Elizabeth McMahan
- Ryota Nakagi
All providers in Scooba, MS · General Practice Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.