Healthcare Provider Details

I. General information

NPI: 1013092600
Provider Name (Legal Business Name): MISSISSIPPI BAND OF CHOCTAW INDIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 CAMPUS RD
CONEHATTA MS
39057-2800
US

IV. Provider business mailing address

210 HOSPITAL CIR
CHOCTAW MS
39350-6781
US

V. Phone/Fax

Practice location:
  • Phone: 601-656-2211
  • Fax: 601-663-7721
Mailing address:
  • Phone: 601-656-2211
  • Fax: 601-663-7721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. PHYLLILS J ANDERSON
Title or Position: TRIBAL CHIEF
Credential:
Phone: 601-656-2211