Healthcare Provider Details

I. General information

NPI: 1962748087
Provider Name (Legal Business Name): SOUTHWEST MISSISSIPPI PLANNING AND DEVELOPMENT DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S WALL ST
NATCHEZ MS
39120-3477
US

IV. Provider business mailing address

100 S WALL ST
NATCHEZ MS
39120-3477
US

V. Phone/Fax

Practice location:
  • Phone: 601-446-6044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WIRT PETERSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 601-446-6044