Healthcare Provider Details

I. General information

NPI: 1093785859
Provider Name (Legal Business Name): UHS OF PARKWOOD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 GOODMAN RD
OLIVE BRANCH MS
38654-2103
US

IV. Provider business mailing address

8135 GOODMAN RD
OLIVE BRANCH MS
38654-2103
US

V. Phone/Fax

Practice location:
  • Phone: 662-895-4900
  • Fax:
Mailing address:
  • Phone: 662-895-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number32316
License Number StateMS

VIII. Authorized Official

Name: MRS. SANDRA WALLACE
Title or Position: CFO
Credential:
Phone: 662-893-7093