MEDICARE: MS STATE DEPARTMENT OF HEALTH

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	251E00000X	Home Health Agency	7881	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730164674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MS STATE DEPARTMENT OF HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 1700
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39215-1700
Country	:	US
Telephone Number	:	601-987-4995
Fax Number	:	601-987-8633

Provider Business Practice Location Address
First Line	:	350 WEST WOODROW WILSON AVENUE
Second Line	:	HINDS COUNTY HEALTH DEPARTMENT SUITE 411-A
City	:	JACKSON
State	:	MS
Zip	:	39213
Country	:	US
Telephone Number	:	601-987-4995
Fax Number	:	601-987-8633

Authorized Official
Title or Position	:	DIRECTOR OF HOME HEALTH
Name	:	MRS. MELANIE BOWMAN
Credential	:	RN
Telephone Number	:	601-576-7853

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/14/2008

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Directions to “MS STATE DEPARTMENT OF HEALTH ” Practice Location

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