=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184100331
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MS STATE VETERANS HOME OXFORD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2018
-----------------------------------------------------
Last Update Date | 07/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 VETERANS DR
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655-3578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-236-7641
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 VETERANS DR
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655-3578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-236-7641
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | CASSIE ARNOLD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-236-7641
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------