MEDICARE: CHOCTAW COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1326350240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOCTAW COUNTY

Provider Business Mailing Address
First Line	:	119 WEST CHERRY STREET
Second Line	:
City	:	ACKERMAN
State	:	MS
Zip	:	39735-0000
Country	:	US
Telephone Number	:	601-849-1682
Fax Number	:	601-849-1969

Provider Business Practice Location Address
First Line	:	119 WEST CHERRY STREET
Second Line	:
City	:	ACKERMAN
State	:	MS
Zip	:	39735-0000
Country	:	US
Telephone Number	:	601-849-1682
Fax Number	:	601-849-1969

Authorized Official
Title or Position	:	PRESIDENT OF THE BOARD
Name	:	MR. THOMAS F HIGGINS SR.
Credential	:
Telephone Number	:	662-285-6329

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	07/08/2010

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Directions to “CHOCTAW COUNTY ” Practice Location

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