Healthcare Provider Details

I. General information

NPI: 1164422580
Provider Name (Legal Business Name): MISSISSIPPI UNIVERSITY FOR WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 10TH ST SOUTH CROMWELL BLDG ROOM 129
COLUMBUS MS
39701
US

IV. Provider business mailing address

1100 COLLEGE ST MUW-1340
COLUMBUS MS
39701-5800
US

V. Phone/Fax

Practice location:
  • Phone: 662-329-7270
  • Fax: 662-329-7460
Mailing address:
  • Phone: 662-329-7270
  • Fax: 662-329-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY JOY TOWNSEND
Title or Position: INTERIM DIRECTOR
Credential: MS CCC SLP
Phone: 662-329-7270