MEDICARE: CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1639024623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC

Provider Business Mailing Address
First Line	:	3502 W NORTHSIDE DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39213-4454
Country	:	US
Telephone Number	:	601-362-5321
Fax Number	:	601-364-5159

Provider Business Practice Location Address
First Line	:	350 W WOODROW WILSON AVE
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39213-7681
Country	:	US
Telephone Number	:	601-362-5321
Fax Number	:	601-364-5159

Authorized Official
Title or Position	:	AM
Name	:	LINDA SWILLEY
Credential	:
Telephone Number	:	601-540-6898

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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