Healthcare Provider Details

I. General information

NPI: 1033222922
Provider Name (Legal Business Name): CENTRAL MISSISSIPPI MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CHADWICK DR
JACKSON MS
39204-3404
US

IV. Provider business mailing address

1850 CHADWICK DR
JACKSON SC
39204
US

V. Phone/Fax

Practice location:
  • Phone: 601-376-1033
  • Fax: 601-376-1144
Mailing address:
  • Phone: 601-376-1033
  • Fax: 601-376-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number001
License Number StateMS

VIII. Authorized Official

Name: MRS. SHIRLENE MINOR
Title or Position: MEDICAID BILLER
Credential: HOSPITAL
Phone: 601-376-1033