National Provider Identifier Database

MID SOUTH DIRECT PRIMARY CARE
Primary Care


Contact Information

MID-SOUTH DIRECT PRIMARY CARE
1229 MS-42 SUITE 270
PETAL, MS39465
Phone: 769-223-9503
Fax: 601-336-4925
Website:
Specialty Taxonomy Code
* Primary Care 261QP2300X

* Indicates primary specialty

NPI Profile & details for MID-SOUTH DIRECT PRIMARY CARE

NPI Number 1346036977
Legal business name
LBN
MID-SOUTH DIRECT PRIMARY CARE
Authorized official ASHLEE HENDRY - (D.O./ADMINISTRATOR)
Entity Organization
Organization subpart Yes
Enumeration date 04/18/2025
Last updated 04/18/2025 - More than a year ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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