Healthcare Provider Details

I. General information

NPI: 1891169306
Provider Name (Legal Business Name): F.C. OF MISSISSIPPI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 FERNCLIFF DRIVE SUTIES 1 & 3
SOUTHAVEN MS
38671-2433
US

IV. Provider business mailing address

3220 KELLER SPRINGS RD STE 108
CARROLLTON TX
75006-5911
US

V. Phone/Fax

Practice location:
  • Phone: 662-393-0109
  • Fax: 662-393-4306
Mailing address:
  • Phone: 214-442-0967
  • Fax: 214-445-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7294
License Number StateMS

VIII. Authorized Official

Name: JOHN M NIX
Title or Position: CFO
Credential:
Phone: 214-445-3750