Provider Demographics
NPI:1447989082
Name:PROFESSIONAL QUALITY HEALTHCARE
Entity type:Organization
Organization Name:PROFESSIONAL QUALITY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:REGINAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:769-867-1455
Mailing Address - Street 1:2310 HIGHWAY 80 W STE 2260
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-2383
Mailing Address - Country:US
Mailing Address - Phone:769-867-1455
Mailing Address - Fax:
Practice Address - Street 1:2310 HIGHWAY 80 W STE 2260
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-2383
Practice Address - Country:US
Practice Address - Phone:769-867-1455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty