Healthcare Provider Details

I. General information

NPI: 1124215785
Provider Name (Legal Business Name): MISSISSIPPI DEPARTMENT OF REHABILITAION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 HIGHWAY 51 NORTH
JACKSON MS
39215-1698
US

IV. Provider business mailing address

P.O. BOX 1698 1281 HIGHWAY 51 NORTH
JACKSON MS
39215-1698
US

V. Phone/Fax

Practice location:
  • Phone: 601-853-5324
  • Fax: 601-853-5301
Mailing address:
  • Phone: 601-853-5324
  • Fax: 601-853-5301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. H.S. BUTCH MCMILLAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 601-853-5200