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General NPI Number Information
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NPI Number | 1679630008
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Entity Type | Organization
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Legal Business Name | SOUTH MISSISSIPPI STATE HOSPITAL
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 823 HIGHWAY 589
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City | PURVIS
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State | MS
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Zip | 39475-4194
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Country | US
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Telephone | 601-794-0201
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Fax | 601-794-0220
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Provider Business Mailing Address
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Address Line | 823 HIGHWAY 589
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City | PURVIS
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State | MS
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Zip | 39475-4194
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Country | US
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Telephone | 601-794-0201
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Fax | 601-794-0220
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Authorized Official
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Title or Position | HOSPITAL DIRECTOR
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Name | CLINT ASHLEY
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Credential |
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Telephone | 601-794-0152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 04871/3.1
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License Number State | MS
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