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General NPI Number Information
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NPI Number | 1346522653
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Entity Type | Organization
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Legal Business Name | EAST MISSISSIPPI STATE HOSPITAL
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 1818 COLLEGE DRIVE
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City | MERIDIAN
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State | MS
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Zip | 39307-5429
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Country | US
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Telephone | 601-581-7562
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Fax | 601-581-7676
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Provider Business Mailing Address
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Address Line | 1818 COLLEGE DRIVE
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City | MERIDIAN
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State | MS
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Zip | 39307-5429
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Country | US
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Telephone | 601-581-7562
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Fax | 601-581-7676
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Authorized Official
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Title or Position | HOSPITAL DIRECTOR
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Name | CHARLES CARLISLE
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Credential |
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Telephone | 601-581-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 31-136
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License Number State | MS
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