Healthcare Provider Details

I. General information

NPI: 1902965866
Provider Name (Legal Business Name): OCH CENTER FOR PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 DOCTORS PARK
STARKVILLE MS
39759-2174
US

IV. Provider business mailing address

PO BOX 1326
STARKVILLE MS
39760-1326
US

V. Phone/Fax

Practice location:
  • Phone: 662-615-3751
  • Fax: 662-615-3754
Mailing address:
  • Phone: 662-615-2830
  • Fax: 662-615-2836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number11-269
License Number StateMS

VIII. Authorized Official

Name: MR. JAMES H. JACKSON JR.
Title or Position: CEO
Credential:
Phone: 662-615-2500