Healthcare Provider Details

I. General information

NPI: 1528436862
Provider Name (Legal Business Name): REGION IV THE HUB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7139C COMMERCE DR
OLIVE BRANCH MS
38654-2114
US

IV. Provider business mailing address

PO BOX 839
CORINTH MS
38835-0839
US

V. Phone/Fax

Practice location:
  • Phone: 662-420-7387
  • Fax:
Mailing address:
  • Phone: 662-286-9883
  • Fax: 662-284-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberREG4-AGENGY
License Number StateMS

VIII. Authorized Official

Name: MR. JASON RAMEY
Title or Position: INTERIM DIRECTOR
Credential:
Phone: 662-286-9883