Healthcare Provider Details

I. General information

NPI: 1841711546
Provider Name (Legal Business Name): MISSISSIPPI BAPTIST MINISTRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 DAVID PATTERSON RD
MOSELLE MS
39459-9439
US

IV. Provider business mailing address

PO BOX 334
MOSELLE MS
39459-0334
US

V. Phone/Fax

Practice location:
  • Phone: 601-596-3786
  • Fax:
Mailing address:
  • Phone: 601-596-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: BRENT F BROOME
Title or Position: EXECUTIVE DIRECTOR
Credential: ED
Phone: 601-596-3786