Healthcare Provider Details

I. General information

NPI: 1598676876
Provider Name (Legal Business Name): CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5677 HIGHLAND DR
JACKSON MS
39206-3517
US

IV. Provider business mailing address

3502 W NORTHSIDE DR JAC JACK
JACKSON MS
39213-4454
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-5321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JO ANN SMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-362-5321