GLEN KERMIT TILL (NPI# 1093999807) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093999807 |
| Entity Type | Individual |
| Full Name | GLEN KERMIT TILL |
| Credential | MD |
| Practice Address |
348 Crossgates Blvd Suite 2400 Brandon MS 39042-2700 |
| Practice Telephone | 6018250003 |
| Practice Fax Number | 6018250013 |
| Mailing Telephone | 6018250003 |
| Mailing Fax Number | 6018250013 |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2007-12-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 04727 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00115355 | 05 |
| Street Address |
348 CROSSGATES BLVD SUITE 2400 |
| City | BRANDON |
| State | MS |
| Zip Code | 39042-2700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427073386 | Edward E Rigdon | Surgery | 348 Crossgates Blvd, Suite 2500, Brandon, MS 39042-2700 | 2006-07-13 |
| 1144524596 | Edward E. Rigdon, M.d., Inc. | Surgery | 348 Crossgates Blvd, Suite 2500, Brandon, MS 39042-2700 | 2010-12-28 |
| 1720396864 | Crossgates Hma Medical Group, LLC | Pediatrics | 348 Crossgates Blvd, Suite 1500, Brandon, MS 39042-2700 | 2010-09-23 |
| 1508096009 | River Oaks Management, LLC | Neurological Surgery | 348 Crossgates Blvd, 1500, Brandon, MS 39042-2700 | 2009-07-17 |
| 1609016443 | Central Mississippi Neurology Group Pa | Specialist | 348 Crossgates Blvd, Ste 2300, Brandon, MS 39042-2700 | 2009-03-05 |
| 1487838983 | Rankin Plastic Surgery Center | Plastic Surgery | 348 Crossgates Blvd, Suite 2400, Brandon, MS 39042-2700 | 2007-12-20 |
| 1760673594 | Brandon Clinic | Family Medicine | 348 Crossgates Blvd, Suite 1200, Brandon, MS 39042-2700 | 2007-08-07 |
| 1578762027 | Arno R Schleich | Plastic Surgery | 348 Crossgates Blvd, Suite 1200, Brandon, MS 39042-2700 | 2007-07-15 |
| 1033231998 | Ken R. Morris M.d. P.a. | Family Medicine | 348 Crossgates Blvd, Suite 1300, Brandon, MS 39042 | 2007-04-04 |
| 1679672745 | Richard C Randolph Md Pa | Family Medicine | 348 Crossgates Blvd, Suite 2200, Brandon, MS 39042-2616 | 2006-09-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740821529 | Claudia Francis Jones | Technician | 1008 Greenfield Circle, Brandon, MS 39042 | 2019-10-03 |
| 1194294546 | Allen Keith Johnson Jr. | Counselor | 1700 West Government Street Building B. Suite O., Brandon, MS 39042 | 2018-11-15 |
| 1689167462 | Regional Home Care and Infusions, Inc. | Registered Nurse | 302 Town Square, Suite 110, Brandon, MS 39042 | 2018-06-07 |
| 1013419563 | Brandon Family Chiropractic LLC | Chiropractor | 1350 West Government Street Suite A1, Brandon, MS 39042 | 2018-03-01 |
| 1184146789 | Lakeland Home Program LLC | Clinic/Center | 209 Mar Lyn Dr, Brandon, MS 39042 | 2017-07-14 |
| 1104275510 | Matthew Logue | Community Health Worker | 2009 Mossy Cove, Brandon, MS 39042 | 2016-06-07 |
| 1932569704 | Haley Wilson | Chiropractor | 1350 W Government St Ste A1, Brandon, MS 39042 | 2016-03-07 |
| 1548698608 | St Dominic Medical Associates LLC | Family Medicine | 1297 West Government Street, Brandon, MS 39042 | 2013-10-28 |
| 1760825434 | Linda J. Bridges | Respiratory Therapist, Certified | 330 Rankin Road, Brandon, UNITED STATES 39042 | 2013-04-12 |
| 1861739922 | Georgia Christine Shirley | Nurse Practitioner | 2008 Brookstone Place, Brandon, MS 39042 | 2013-01-09 |
| Find all providers in zip 39042 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900581 | Maegan Cook Bridges | Family Medicine | 312 Ridge Pointe Dr, Brandon, MS 39042-5035 | 2020-10-24 |
| 1346887353 | Kelli Marie Foster | Family Medicine | 515 Belle Oak Pl, Brandon, MS 39042-8111 | 2019-12-09 |
| 1649764127 | Specialty Diagnostics LLC | Family Medicine | 1149 Old Fannin Rd Ste 22, Brandon, MS 39047 | 2018-06-19 |
| 1033566161 | Medi Brandon LLC | Family Medicine | 203 W Bloomingdale Ave, Brandon, FL 33511-7404 | 2016-05-18 |
| 1144659178 | Medical Foundation of Central Ms, Inc | Family Medicine | 1887 Spillway Rd., Brandon, MS 39047 | 2013-11-12 |
| 1457780637 | Jennifer Packing-ebuen | Family Medicine | 426w Brandon Blvd, Brandon, FL 33511-5002 | 2013-11-07 |
| 1548698608 | St Dominic Medical Associates LLC | Family Medicine | 1297 West Government Street, Brandon, MS 39042 | 2013-10-28 |
| 1265780910 | Uc1, LLC | Family Medicine | 799 Lumsden Rd, Brandon, FL 33511 | 2012-08-28 |
| 1992082721 | Mathew Medical Consulting Pa | Family Medicine | 635 Tuscanny St, Brandon, FL 33511-6165 | 2011-11-08 |
| 1003192246 | Sandra Dorsey | Family Medicine | 122 South Moon Avenue, Brandon, FL 33511 | 2011-11-02 |
| Find all providers in BRANDON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.