Healthcare Provider Details

I. General information

NPI: 1184100331
Provider Name (Legal Business Name): MS STATE VETERANS HOME OXFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 VETERANS DR
OXFORD MS
38655-3578
US

IV. Provider business mailing address

120 VETERANS DR
OXFORD MS
38655-3578
US

V. Phone/Fax

Practice location:
  • Phone: 662-236-7641
  • Fax:
Mailing address:
  • Phone: 662-236-7641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateMS

VIII. Authorized Official

Name: CASSIE ARNOLD
Title or Position: PHARMACIST
Credential:
Phone: 662-236-7641