Healthcare Provider Details

I. General information

NPI: 1457666083
Provider Name (Legal Business Name): CHOCTAW COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W CHERRY ST
ACKERMAN MS
39735-8708
US

IV. Provider business mailing address

311 W CHERRY ST
ACKERMAN MS
39735-8708
US

V. Phone/Fax

Practice location:
  • Phone: 601-849-1682
  • Fax: 601-849-1969
Mailing address:
  • Phone: 601-849-1682
  • Fax: 601-849-1969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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