Healthcare Provider Details

I. General information

NPI: 1952384471
Provider Name (Legal Business Name): MISSISSIPPI STATE DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2071 MAGNOLIA OFFICE PARK HIGHWAY 35 S
FOREST MS
39074-0150
US

IV. Provider business mailing address

PO BOX 150 2071 MAGNOLIA OFFICE PARK
FOREST MS
39074-0150
US

V. Phone/Fax

Practice location:
  • Phone: 601-469-3043
  • Fax: 601-469-2996
Mailing address:
  • Phone: 601-469-3043
  • Fax: 601-469-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number10081
License Number StateMS

VIII. Authorized Official

Name: MRS. MELANIE BOWMAN
Title or Position: DIRECTOR OF HOME HEALTH
Credential: RN
Phone: 601-576-7853