| Desoto Osteopathic | |
|
187 Stateline Rd E Suite #10 Southaven MS 38671-1704 | |
| (662) 342-5353 | |
| (662) 393-9753 |
| Full Name | Desoto Osteopathic |
|---|---|
| Speciality | Internal Medicine |
| Location | 187 Stateline Rd E, Southaven, Mississippi |
| Authorized Official Name and Position | Debbie Clark (BILLER) |
| Authorized Official Contact | 6624295221 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Desoto Osteopathic 187 Stateline Rd E Suite #10 Southaven MS 38671-1704 Ph: (662) 342-5353 | Desoto Osteopathic 187 Stateline Rd E Suite #10 Southaven MS 38671-1704 Ph: (662) 342-5353 |
| NPI Number | 1558382200 |
|---|---|
| Provider Enumeration Date | 07/21/2006 |
| Last Update Date | 10/22/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558382200 | NPI | - | NPPES |
| 4031960 | Other | TN | BLUE CROSS OF TENNESSEE |
| 0118418 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 15380 (Mississippi) | Primary |
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