Healthcare Provider Details

I. General information

NPI: 1598750135
Provider Name (Legal Business Name): MISSISSIPPI STATE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 HIGHWAY 468 W
WHITFIELD MS
39193
US

IV. Provider business mailing address

PO BOX 157A BUILDING 50 PHARMACY
WHITFIELD MS
39193-0157
US

V. Phone/Fax

Practice location:
  • Phone: 601-351-8000
  • Fax: 601-351-8255
Mailing address:
  • Phone: 601-351-8026
  • Fax: 601-351-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number01000/03.1
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number01000
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number01000
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. VICKI S. VEAZEY
Title or Position: PHARMACY DIRECTOR
Credential: RPH
Phone: 601-351-8026