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General NPI Number Information
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NPI Number | 1649419532
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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 | 02/17/2009
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 2500 N STATE ST H120
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-815-1686
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Fax | 601-815-1689
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Provider Business Mailing Address
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Address Line | 2500 N STATE ST H120
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-815-1686
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Fax | 601-815-1689
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 07796/05.1
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License Number State | MS
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