Healthcare Provider Details

I. General information

NPI: 1922083872
Provider Name (Legal Business Name): MS STATE DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PRESTON MCKAY DR
SENATOBIA MS
38668-2350
US

IV. Provider business mailing address

100 PRESTON MCKAY DR
SENATOBIA MS
38668-2350
US

V. Phone/Fax

Practice location:
  • Phone: 662-562-4014
  • Fax: 662-562-9535
Mailing address:
  • Phone: 662-562-4014
  • Fax: 662-562-9535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number11681
License Number StateMS

VIII. Authorized Official

Name: MRS. MELANIE BOWMAN
Title or Position: DIRECTOR OF HOME HEALTH
Credential: RN
Phone: 601-576-7853