Basic Information
| Provider Information | |||||||||
| NPI: | 1700073897 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MANIMEKALAI | ||||||||
| FirstName: | NATESAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 N STATE ST | ||||||||
| Address2: | DEPT OF ANESTHESIOLOGY | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019845900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 N STATE ST | ||||||||
| Address2: | DEPT OF ANESTHESIOLOGY | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019845900 | ||||||||
| FaxNumber: | 6019846439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2007 | ||||||||
| LastUpdateDate: | 10/15/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME97927 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 22847 | MS | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 03950227 | 05 | MS | MEDICAID | 2797470-00 | 05 | FL | MEDICAID | P010508103 | 01 | MS | RAILROAD MEDICARE PTAN | OTHER | 785534386A | 05 | GA | MEDICAID |