Healthcare Provider Details

I. General information

NPI: 1457330995
Provider Name (Legal Business Name): SOUTH MISSISSIPPI STATE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 HIGHWAY 589
PURVIS MS
39475-4194
US

IV. Provider business mailing address

823 HIGHWAY 589
PURVIS MS
39475-4194
US

V. Phone/Fax

Practice location:
  • Phone: 601-794-0100
  • Fax: 601-794-0213
Mailing address:
  • Phone: 601-794-0100
  • Fax: 601-794-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number31329
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number31336
License Number StateMS

VIII. Authorized Official

Name: MRS. WYNONA WINFIELD
Title or Position: HOSPITAL DIRECTOR
Credential:
Phone: 601-794-0100