Provider Demographics
NPI:1043053119
Name:MISSISSIPPI MEDICAL ARTS LLC
Entity type:Organization
Organization Name:MISSISSIPPI MEDICAL ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SORIANO-PALACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-656-5815
Mailing Address - Street 1:517 CENTER AVE N
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2552
Mailing Address - Country:US
Mailing Address - Phone:601-656-5815
Mailing Address - Fax:601-656-8510
Practice Address - Street 1:517 CENTER AVE N
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2552
Practice Address - Country:US
Practice Address - Phone:601-656-5815
Practice Address - Fax:601-656-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty