Provider Demographics
NPI:1851271159
Name:MISSISSIPPI UROLOGY CLINIC, PLLC
Entity type:Organization
Organization Name:MISSISSIPPI UROLOGY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-985-3169
Mailing Address - Street 1:501 MARSHALL ST STE 301
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1687
Mailing Address - Country:US
Mailing Address - Phone:601-985-3169
Mailing Address - Fax:601-353-3654
Practice Address - Street 1:1029 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9554
Practice Address - Country:US
Practice Address - Phone:601-353-9900
Practice Address - Fax:601-353-3654
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSISSIPPI UROLOGY CLINIC, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site