Provider Demographics
NPI:1770745861
Name:YAZOO FAMILY MEDICINE PA
Entity type:Organization
Organization Name:YAZOO FAMILY MEDICINE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-746-6083
Mailing Address - Street 1:PO BOX 1509
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-1509
Mailing Address - Country:US
Mailing Address - Phone:662-746-6083
Mailing Address - Fax:662-746-1954
Practice Address - Street 1:805 E FIFTEENTH ST
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-7607
Practice Address - Country:US
Practice Address - Phone:662-746-6083
Practice Address - Fax:662-746-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6170300001Medicare NSC