| Medical Spark | |
|
2906 N State St Jackson MS 39216-4233 | |
| (601) 594-7107 | |
| Not Available |
| Full Name | Medical Spark |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2906 N State St, Jackson, Mississippi |
| Authorized Official Name and Position | Chip Slack (CEO) |
| Authorized Official Contact | 6015947107 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Spark 2906 N State St Jackson MS 39216-4233 Ph: (601) 594-7107 | Medical Spark 2906 N State St Jackson MS 39216-4233 Ph: (601) 594-7107 |
| NPI Number | 1790089324 |
|---|---|
| Provider Enumeration Date | 12/22/2010 |
| Last Update Date | 12/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790089324 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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