NPI Code Details Logo

NPI 1063324911

NPI 1063324911 : CENTRAL MS CIVIC IMPROVEMENT ASSOCIATION, INC : JACKSON, MS

=====================================================
General NPI Number Information
=====================================================
    NPI Number           |    1063324911
-----------------------------------------------------
    Entity Type          |    Organization 
-----------------------------------------------------
    Legal Business Name  |    CENTRAL MS CIVIC IMPROVEMENT ASSOCIATION, INC 
-----------------------------------------------------

=====================================================
Dates
=====================================================
    Enumeration Date     |    09/17/2026
-----------------------------------------------------
    Last Update Date     |    09/17/2026
-----------------------------------------------------

=====================================================
Provider Practice Location Address
=====================================================
    Address Line         |    186 IDLEWILD ST 
-----------------------------------------------------
    City                 |    JACKSON
-----------------------------------------------------
    State                |    MS
-----------------------------------------------------
    Zip                  |    39203-1296
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    601-362-5321
-----------------------------------------------------
    Fax                  |    
-----------------------------------------------------

=====================================================
Provider Business Mailing Address
=====================================================
    Address Line         |    3502 W NORTHSIDE DR 
-----------------------------------------------------
    City                 |    JACKSON
-----------------------------------------------------
    State                |    MS
-----------------------------------------------------
    Zip                  |    39213-4454
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    601-362-5321
-----------------------------------------------------
    Fax                  |    
-----------------------------------------------------

=====================================================
Authorized Official
=====================================================
    Title or Position    |    ADMINISTRATOR
-----------------------------------------------------
    Name                 |     LINDA  SWILLEY 
-----------------------------------------------------
    Credential           |    
-----------------------------------------------------
    Telephone            |    601-540-6898
-----------------------------------------------------

=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
    Taxonomy Code        |    261QF0400X
-----------------------------------------------------
    Taxonomy Name        |    Federally Qualified Health Center (FQHC)
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------



                        

Copyright © 2007-2026 Data Labs Health. All rights reserved.