Provider Demographics
NPI:1184941676
Name:ONCALL MEDICAL CLINIC, PLLC
Entity type:Organization
Organization Name:ONCALL MEDICAL CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:FLOYD
Authorized Official - Last Name:ALDRIDGE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:228-818-5155
Mailing Address - Street 1:3091 BIENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-4308
Mailing Address - Country:US
Mailing Address - Phone:228-818-5155
Mailing Address - Fax:228-818-5159
Practice Address - Street 1:3091 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4308
Practice Address - Country:US
Practice Address - Phone:228-818-5155
Practice Address - Fax:228-818-5159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11483305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization