Healthcare Provider Details

I. General information

NPI: 1306968904
Provider Name (Legal Business Name): OCH CENTER FOR BREAST HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOSPITAL ROAD
STARKVILLE MS
39759-2163
US

IV. Provider business mailing address

PO BOX 942
STARKVILLE MS
39760-0942
US

V. Phone/Fax

Practice location:
  • Phone: 662-615-3800
  • Fax: 662-615-3807
Mailing address:
  • Phone: 662-615-2800
  • Fax: 662-615-3807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number11-269
License Number StateMS

VIII. Authorized Official

Name: MR. RICHARD G HILTON
Title or Position: ASSOCIATE ADMINISTRATOR
Credential:
Phone: 662-615-2503