Provider Demographics
NPI:1780778928
Name:KAREN M BRUCE MD PLLC
Entity type:Organization
Organization Name:KAREN M BRUCE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:HEMPHILL
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-849-1200
Mailing Address - Street 1:360 SIMPSON HIGHWAY 149
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-3841
Mailing Address - Country:US
Mailing Address - Phone:601-849-1200
Mailing Address - Fax:601-849-3112
Practice Address - Street 1:360 SIMPSON HIGHWAY 149
Practice Address - Street 2:SUITE 350
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3841
Practice Address - Country:US
Practice Address - Phone:601-849-1200
Practice Address - Fax:601-849-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00725822Medicaid
MS080004083Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MS00725822Medicaid