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General NPI Number Information
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NPI Number | 1164722559
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI STATE DEPARTMENT OF HEALTH
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 4600 VEGA ST
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City | PASCAGOULA
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State | MS
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Zip | 39581-5303
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Country | US
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Telephone | 228-762-1117
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 VEGA ST
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City | PASCAGOULA
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State | MS
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Zip | 39581-5303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARTHA DAVIS
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Credential |
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Telephone | 228-762-1117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number | R863092
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License Number State | MS
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