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General NPI Number Information
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NPI Number | 1730164674
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Entity Type | Organization
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Legal Business Name | MS STATE DEPARTMENT OF HEALTH
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 350 WEST WOODROW WILSON AVENUE HINDS COUNTY HEALTH DEPARTMENT SUITE 411-A
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City | JACKSON
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State | MS
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Zip | 39213
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Country | US
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Telephone | 601-987-4995
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Fax | 601-987-8633
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Provider Business Mailing Address
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Address Line | PO BOX 1700
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City | JACKSON
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State | MS
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Zip | 39215-1700
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Country | US
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Telephone | 601-987-4995
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Fax | 601-987-8633
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Authorized Official
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Title or Position | DIRECTOR OF HOME HEALTH
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Name | MRS. MELANIE BOWMAN
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Credential | RN
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Telephone | 601-576-7853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 7881
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License Number State | MS
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