Provider Demographics
NPI:1902140635
Name:CARDIOVASCULAR INSTITUTE OF MISSISSIPPI, LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR INSTITUTE OF MISSISSIPPI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:GHAFOUR
Authorized Official - Last Name:BAHRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-529-1600
Mailing Address - Street 1:1031 N FLOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9533
Mailing Address - Country:US
Mailing Address - Phone:601-487-7445
Mailing Address - Fax:601-487-7446
Practice Address - Street 1:1031 N FLOWOOD DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9533
Practice Address - Country:US
Practice Address - Phone:601-487-7445
Practice Address - Fax:601-487-7446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16080207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty