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General NPI Number Information
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NPI Number | 1568254100
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Entity Type | Organization
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Legal Business Name | STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 764 LAKELAND DR
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City | JACKSON
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State | MS
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Zip | 39216-4651
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Country | US
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Telephone | 601-984-5020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11407
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City | BIRMINGHAM
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State | AL
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Zip | 35246-2130
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Country | US
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Telephone | 601-984-1000
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE CFO - CLINICAL OPERATIONS
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Name | JEFFREY GRIMSLEY
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Credential |
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Telephone | 601-815-6270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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