Healthcare Provider Details

I. General information

NPI: 1013990530
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: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 S JACKSON ST ROUTE 1 BOX 1049
HOUSTON MS
38851-7662
US

IV. Provider business mailing address

797 S JACKSON ST ROUTE 1 BOX 1049
HOUSTON MS
38851-7662
US

V. Phone/Fax

Practice location:
  • Phone: 662-456-3791
  • Fax: 662-456-3979
Mailing address:
  • Phone: 662-456-3791
  • Fax: 662-456-3979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1381
License Number StateMS

VIII. Authorized Official

Name: DR. DANIEL P EDNEY
Title or Position: STATE HEALTH OFFICER
Credential: MD, FACP
Phone: 601-576-7634