Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2016-06-10
- Last updated
- 2016-06-10
Licenses
The registry row did not include a license.
Location
- Practice location
- 317 HIGHWAY 13 S
- City
- MORTON MS
- Postal code
- 391173353
- Phone
- 469-401-2386
Organization contact
- Name
- GREGORY BYRNE
- Title
- Officer
- Phone
- 4694012386
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.